Category Archives: Exercise addiction

We can work it out: A brief look at ‘entrepreneurship addiction’

Last month, a paper appeared online in the journal Academy of Management (AJM). I’d never heard of the journal before but its remit is publish empirical research that tests, extends, or builds management theory and contributes to management practice”. The paper I came across was entitled ‘Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns’ – and is an addiction that I’d never heard of before. The authors of the paper – April Spivack and Alexander McKelvie – 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”. Going by the title of the paper alone, I assumed ‘entrepreneurship addiction’ was another name for ‘work addiction’ or ‘workaholism’ but the authors state:

“We address what is unique about this type of behavioral addiction compared to related work pattern concepts of workaholism, entrepreneurial passion, and work engagement. We identify new and promising areas to expand understanding of what factors lead to entrepreneurship addiction, what entrepreneurship addiction leads to, how to effectively study entrepreneurship addiction, and other applications where entrepreneurship addiction might be relevant to study. These help to set a research agenda that more fully addresses a potential ‘dark side’ psychological factor among some entrepreneurs”.

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The paper is a theoretical paper and doesn’t include any primary data collection. The authors had published a previous 2014 paper in the Journal of Business Venturing, on the same topic (‘Habitual entrepreneurs: Possible cases of entrepreneurship addiction?’) based on case study interviews with two habitual entrepreneurs. In that paper the authors argued that addiction symptoms can manifest in the entrepreneurial context. Much of the two papers uses the ‘workaholism’ literature to ground the term but the authors do view ‘entrepreneurship addiction’ and ‘work addiction’ as two separate entities (although my own view is that entrepreneurship addiction’ is a sub-type of ‘work addiction’ based on what I’ve read – in fact I would argue that all ‘entrepreneurship addicts’ are work addicts but not all work addicts are ‘entrepreneurship addicts’). Spivak and McKelvie are right to assert that entrepreneurship addiction is a relatively new term and represents an emerging area of inquiry” and that “reliable prevalence rates are currently unknown”.

The aim of the AJM paper is to “situate entrepreneurship addiction as a distinct concept” and to examine entrepreneurship addiction in relation to other similar work patterns (i.e., workaholism, work engagement, and entrepreneurial passion). Like my own six component model of addiction, Spivak and McKelvie also have six components (and are similar to my own) which are presented below verbatim from their AJM paper:

  • Obsessive thoughts – constantly thinking about the behavior and continually searching for novelties within the behavior;
  • Withdrawal/engagement cycles – feeling anticipation and undertaking ritualized behavior, experiencing anxiety or tension when away, and giving into a compulsion to engage in the behavior whenever possible;
  • Self-worth – viewing the behavior as the main source of self-worth;
  • Tolerance – making increasing resource (e.g., time and money) investments;
  • Neglect – disregarding or abandoning previously important friends and activities;
  • Negative outcomes – experiencing negative emotional outcomes (e.g., guilt, lying, and withholding information about the behavior from others), increased or high levels of strain, and negative physiological/health outcomes.

As in my own writings on work addiction (see ‘Further reading’ below), Spivak and McKelvie also note that even when addicted, there may still be some positive outcomes and/or benefits from such behaviour (as can be found in other behavioural addictions such as exercise addiction). As noted in the AJM paper:

“Some of these positive outcomes may include benefits to the business venture including quick responsiveness to competitive pressures or customer demands and high levels of innovation, while benefits to the individual may include high levels of autonomy, financial security, and job satisfaction. It is the complexity of these relationships, or the combined positive and negative outcomes, that may obscure the dysfunctional dark side elements of entrepreneurship addiction”.

Spivak and McKelvie also go to great lengths to differentiate entrepreneurship addiction from workaholism (although I ought to point out, I have recently argued in a paper in the Journal of Behavioral Addictions [‘Ten myths about work addiction’] that ‘workaholism’ and ‘work addiction’ are not the same thing, and outlined in a previous blog). Spivak and McKelvie concede that entrepreneurship addiction is a “sister construct” to ‘workaholism’ because of the core elements they have in common. More specifically, in relation to similarities, they assert:

“Workaholism, like entrepreneurship addiction, emphasizes the compulsion to work, working long hours, obsessive thoughts that extend beyond the domain of work, and results in some of the negative outcomes that have been linked to entrepreneurship addiction, including difficulties in social relationships and diminished physical health (Spivack et al., 2014). Some of the conceptualizations of workaholism draw from the literature on psychological disorders. Similarly, we recognize and propose that there may be significant overlap with various psychological conditions among those that develop entrepreneurship addiction, including, but not limited to, obsessive compulsive disorder, bipolar disorder, and ADD/ADHD”.

However, they then do on to describe what they feel are the practical and conceptual distinctions between entrepreneurship addiction and workaholism. More specifically, they argue that:

“(M)ost workaholics are embedded within existing firms and are delegated tasks and resources in line with the organization’s mission, often in a team-based structure. Most workaholics work on these assigned projects with intensity and some will do so with high levels of engagement, as specified in previous literature. But, in reward for their efforts, many employed workaholics may be limited to receiving recognition and performance bonuses. As a team member employed within the structures of an existing organization, the individual’s contribution to organizational outcomes may be obfuscated just as the reciprocal impact of organizational performance (whether negative or positive) on the individual may be buffered (i.e., there is little chance an employee will lose their home if the business doesn’t perform well). In contrast, entrepreneurs, by definition, are proactive creators of their work context. They are responsible for a myriad of decisions and actions both within and outside of the scope of their initial expertise, and are challenged to situate their work within a dynamic business environment. Entrepreneurs are more clearly linked with their work, as they are responsible for acquiring the resources and implementing them in unique business strategies to create a new entity”.

I would argue that many of the things listed here are not unique to entrepreneurs as I could argue that in my own job as a researcher that I also have many of the benefits outlined above (because within flexible parameters I have a job that I can do what I want, when I want, how I want, and with who I want – there are so many possible rewards in the job I do that it isn’t that far removed from entrepreneurial activity – in fact some of my job now actually includes entrepreneurial activity). As Spivak and McKelvie then go on to say:

“As a result of the intense qualities of the entrepreneurial experience, there are also more intense potential outcomes, whether rewards or punishments in financial, social, and psychological domains. For example, potential rewards for entrepreneurs extend far beyond supervisor recognition and pay bonuses, into the realm of public awareness of accomplishments (or failures), media heralding, and life-changing financial gains or losses. Entrepreneurship addiction thereby moves beyond workaholism into similarities with gambling because of the intensity of the experience and personal risk tied to outcomes”.

I’m not sure I would agree with the gambling analogy, but I agree with the broad thrust of what is being argued (but would still say that entrepreneurship addiction is a sub-type of work addiction). I ought to add that there has also been discussion about the risk of overabundance of unsubstantiated addictive disorders. For instance, in a 2015 paper in the Journal of Behavioral Addiction, Joel Billieux and his colleagues described a hypothetical case of someone they deem fitting into the criteria of the concept of “research addiction” (maybe they had someone like myself in mind?), invented for the purpose of the argument. However, it is worthwhile noting that if their hypothetical example of ‘research addiction’ already fits well into the persisting compulsive over-involvement in job/study to the exclusion of other spheres of life, and if it leads to serious harm (and conflict symptoms suggest that it may) then it could be argued that the person is addicted to work. What we could perhaps agree on, is that for the example of ‘research addiction’ we do not have to invent a new addiction, (just as we do not distinguish between vodka addicts, gin addicts or whisky addicts as there is the overarching construct of alcoholism). Maybe the same argument can be made for entrepreneurship addiction in relation to work addiction.

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

Further reading

Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of norwegian employees. PLoS ONE, 9, e102446. doi:10.1371/journal.pone.0102446

Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265–272. doi:10.1111/sjop.2012.53.issue-3

Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016) The Relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11: e0152978. doi:10.1371/journal.pone.0152978

Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015). Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of Behavioral Addictions, 4, 142–144.

Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R. Eadington & J. Cornelius (Eds.), Gambling Behavior and Problem Gambling (pp. 341-372). Reno, Nevada: University of Nevada Press.

Griffiths, M. D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D., Demetrovics, Z. & Atroszko, P.A. (2018). Ten myths about work addiction. Journal of Behavioral Addictions. Epu ahead of print. doi: 10.1556/2006.7.2018.05

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Paksi, B., Rózsa, S., Kun, B., Arnold, P., Demetrovics, Z. (2009). Addictive behaviors in Hungary: The methodology and sample description of the National Survey on Addiction Problems in Hungary (NSAPH). [in Hungarian] Mentálhigiéné és Pszichoszomatika, 10(4), 273-300.

Quinones, C., & Griffiths, M. D. (2015). Addiction to work: A critical review of the workaholism construct and recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48–59.

Spivack, A., & McKelvie, A. (2017). Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns. The Academy of Management Perspectives. https://doi.org/10.5465/amp.2016.0185

Spivack, A. J., McKelvie, A., & Haynie, J. M. (2014). Habitual entrepreneurs: Possible cases of entrepreneurship addiction? Journal of Business Venturing, 29(5), 651-667.

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.

Term warfare: ‘Workaholism’ and work addiction are not the same

Reliable statistics on the prevalence of individuals addicted to work on a country-by-country basis are almost non-existent. Only two countries (Norway and Hungary) has carried out nationally representative studies. Norwegian studies led by Dr. Cecilie Andreassen reported that approximately 7.3%-8.3% of Norwegians are addicted to work using the Bergen Work Addiction Scale. A Hungarian study led by Dr. Zsolt Demetrovics reported that 8.2% of the 18- to 64-year old population working at least 40 hours a week is at risk for work addiction using the Work Addiction Risk Test.

In a comprehensive literature review that I co-authored using US data, provided a tentative estimation of the prevalence of work addiction among Americans at 10%. Some estimates are as high as 15%-25% among employed individuals although some of these estimates appear to relate to excessive and committed working rather than a genuine addictive behaviour Others claim that the rates of work addiction are high amongst professionals (e.g., lawyers, medics, scientists). Such individuals may work very long hours, expend high effort in their job, delegate rarely, and may not necessarily be more productive. It also appears that those genuinely addicted to work appear to have a compulsive drive to gain approval and success but can result in impaired judgment, poor health, burnout, and breakdowns as opposed to what might be described ‘enthusiastic workaholism’ where few problems are associated with the behaviour.

Word cloud on the subject of workaholism.

Illustration with word cloud on the subject of workaholism

Last month, I and two of my colleagues published a paper in the Journal of Behavioral Addictions examining various myths concerning work addiction. One of the myths we explored was that ‘work addiction is similar to other behavioural addictions’. While work addiction does indeed have many similarities to other behavioural addictions (e.g., gambling, gaming, shopping, sex, etc.), it fundamentally differs from them in a critical way because it is the only behaviour that individuals are typically required to do eight hours a day and is an activity that individuals receive gratification from the local environment and/or society more generally for engaging in the activity. There may also be some benefits from normal [and excessive] work (e.g., financial security through earning a good salary, financial bonuses based on productivity, international travel, free or reduced medical insurance, company car, etc.). Unlike other behavioural and substance addictions where one of the key criteria is typically a negative impact on occupational duties, work addicts cannot negatively impact on the activity they are already engaged in (except in the sense that their addiction to work may impacts on work productivity or work quality due to resulting psychological and/or physical illness).

In some respects, work addiction is similar to exercise addiction in that it is an activity that should be a part of people’s lives and often has some benefits even when engaged in excessively. Such activities have been described by Ian Brown as ‘mixed blessings’ addictions. For instance, in the case of exercise addiction, problematic exercise that interferes with both job and relationships can still have some positive consequences (such as being physically fit). However, it should be emphasized that such positive consequences are typically short lasting, and in the long run, addiction will take its toll on health (even exercise in excess is physiologically unhealthy in the long run in terms of immune function, cardiovascular health, bone health, and mental health). Furthermore, some research suggests that work and exercise addiction have also similar personality correlates different from other addictions, namely high conscientiousness. This might contribute to the fact that work addiction is so perplexing because this personality trait is consistently linked to better health.

Another myth we explored was ‘work addiction and workaholism are the same thing’. The issue of whether ‘workaholism’ and ‘work addiction’ are the same entity depends on how these constructs are defined. For instance, I have argued that any behaviour that fulfils six core components (i.e., salience, conflict, mood modification, tolerance, withdrawal symptoms, and relapse) should be operationalized as an addiction. These six components have also been the basis of many psychometric instruments for assessing potential addictions including work addiction (such as the Bergen Work Addiction Scale that I co-developed and was published in a 2012 issue of the Journal of Scandinavian Psychology). The empirical research carried out by myself and others over the last five years concerning ‘work addiction’ is theoretically rooted in the core addiction literature whereas ‘workaholism’ncludes a wider range of theoretical underpinnings and in some research is a construct seen as something positive rather than negative. Arguably, in popular press and in common everyday language ‘workaholism’ is often used as a positive notiono describe very engaged workers, which adds significantly to the confusion about the two terms.

‘Workaholism’ is arguably a generic term that throughout the literature (as well as by lay people and the popular press) appears to equate to excessive working irrespective of whether the consequences are advantageous or disadvantageous. There is clearly lack of precise dictionary definitions of ‘work addiction’ and ‘workaholism’, and there is no reason to assume they could not be used as synonyms. However, the common use of the term ‘workaholism’ to denote anything related to high involvement in work may suggest that for practical reasons in the professional literature on work addiction, understood within addiction framework, it would be advisable to limit usage of this term. While, it is almost impossible to control natural usage of terms, preference for ‘work addiction’ in addiction literature would be a way to emphasize the addiction framework in which the phenomenon is being conceptualized. In short, ‘work addiction’ is a psychological construct while ‘workaholism’ is arguably a more generic term.

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

Further reading

Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of norwegian employees. PLoS ONE, 9, e102446. doi:10.1371/journal.pone.0102446

Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265–272. doi:10.1111/sjop.2012.53.issue-3

Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016) The Relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11: e0152978. doi:10.1371/journal.pone.0152978

Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R. Eadington & J. Cornelius (Eds.), Gambling Behavior and Problem Gambling (pp. 341-372). Reno, Nevada: University of Nevada Press.

Griffiths, M. D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D., Demetrovics, Z. & Atroszko, P.A. (2018). Ten myths about work addiction. Journal of Behavioral Addictions. Epu ahead of print. doi: 10.1556/2006.7.2018.05

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Paksi, B., Rózsa, S., Kun, B., Arnold, P., Demetrovics, Z. (2009). Addictive behaviors in Hungary: The methodology and sample description of the National Survey on Addiction Problems in Hungary (NSAPH). [in Hungarian] Mentálhigiéné és Pszichoszomatika, 10(4), 273-300.

Quinones, C., & Griffiths, M. D. (2015). Addiction to work: A critical review of the workaholism construct and recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48–59.

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.

Higher and higher: A brief look at rock climbing as an addiction

In previous blogs I have looked at the alleged addictiveness of extreme sports including BASE jumping and bungee jumping as well as briefly overviewing so called ‘adrenaline junkies’. Over the last year, 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 last year 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. For instance, they noted:

Extreme sports athletes commonly describe a “rush” or “high” when participating in their sport (Buckley, 2012; Price & Bundesen, 2005) and liken these experiences to those of drug users (Willig, 2008). For example, a participant in Willig’ s study described: “It’s like for a drug user, they will take cocaine to get high. For me it’s my addiction, I have to go to the mountains to get high.”  Similarly, skydivers have described their sport as “like an addiction,” stating that they “can’t get enough,” and their “relationships suffer” as a result (Celsi, Rose, & Leigh, 1993).”

They also noted prior research suggesting that athletes may experience withdrawal states during periods of abstinence that are also characteristic of those with an addiction. Heirene and his colleagues claimed that this their study was the first to explore withdrawal experiences of individuals engaged in extreme sports. They carried out a study very similar to one of my own where Michael Smeaton and I published a study where gamblers were specifically interviewed about their experiences of withdrawal (in a 2002 issue of Social Psychological Review).

Climate-Change-and-the-Danger-of-Rock-Climbing

Young woman lead climbing in cave, male climber belaying

Heirene’s team used semi-structured interviews to explore withdrawal experiences of what they defined as ‘high ability’ and ‘average-ability’ male rock climbers during periods of abstinence (four climbers in each of the two groups). They then investigated the behavioural and psychological and aspects of withdrawal (including craving, anhedonia [i.e., the inability to feel pleasure in normally pleasurable activities], and negative affect) and examined the differences in the frequency and intensity of these states between the two rock climbing groups. Based on an analysis of the interview transcripts, they found support for the existence of anhedonia, craving, and negative affect among rock climbers. They also reported that the effects were more pronounced and intense among the high ability rock climbers (apart from anhedonic symptoms). The authors also noted:

“All participants reported negative affective experiences during abstinence, including states of “restlessness” and being “miserable,” “agitated,” or “frustrated.” Similar dysphoric states have been identified in drug users, exercise addicts, and extreme sports athletes during abstinence…In the present study, both groups reported using climbing to alleviate negative affective states, particularly stress. This finding supports previous research that has reported skydivers use their sport in a self-medicating manner (Price & Bundesen, 2005). Similarly, psychopharmacology literature has found individuals engage in substance abuse as a means of coping with stress…suggesting similar participation motives in both drug use and extreme sports”.

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 behavioral addictions. In a second investigation just published in Frontiers in Psychology, the same team (this time led by Gareth Roderique-Davies) reported the development of the Rock Climbing Craving Questionnaire (RCCQ). The development of this new psychometric instrument directly followed on from the previous study which had found evidence of craving amongst the rock climbers that had been interviewed.

In the second paper, the research team attempted to “quantitatively measure the craving experienced by participants of any extreme sports”. They claimed that the RCCQ could allow “a greater understanding of the craving experienced by extreme sports athletes and a comparison of these across sports (e.g., surfing) and activities (e.g., drug-use)”. To develop the RCCQ, they utilized previously validated craving measures as a template for the new instrument to assess craving in the sports of rock-climbing and mountaineering.

The second paper comprised two studies. The first study investigated the factor structure of the craving measure among 407 climbers who completed the RCCQ. (One of the limitations of the study was that the participant sample was heterogeneous and included climbers and mountaineers from multiple primary climbing disciplines, including indoor climbing, outdoor traditional climbing, alpine climbing, and ice climbing). Despite the heterogeneity of the sample, the results demonstrated that a three-factor model explained just over half the total variance in item scores. The three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’) each comprised five items. The second study validated the 15-item RCCQ on 254 climbers using confirmatory factor analysis across two conditions (a ‘climbing-related cue’ condition or a ‘cue-neutral’ condition). The authors concluded that:

“[The first study supported] the multi-dimensional nature of rock climbing craving and shows parallels with substance-related craving in reflecting intention and positive (desire) and negative (withdrawal) reinforcement. [The second study confirmed] this factor structure and gives initial validation to the measure with evidence that these factors are sensitive to cue exposure…if as shown here, craving for climbing (and potentially other extreme sports) is similar to that experienced by drug-users and addicts, there is the potential that climbing and other extreme sports could be used as a replacement therapy for drug users”.

This latter suggestion has been made in the literature dating back to the 1970s and the work of Dr. Bill Glasser on ‘positive addictions’ as well as by psychologists such as Iain Brown who suggested in the early 1990s that gambling addicts should replace their addictions with sensation-seeking activities such as sky-diving and parachuting. Critics will claim that these papers are another example of ‘over-pathologizing’ everyday behaviours, but as I have always argued, if any behaviour fulfils all the core criteria for addiction, they should be operationalised as such.

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

Further reading

Brymer, E., & Schweitzer, R. (2013). Extreme sports are good for your health: a phenomenological understanding of fear and anxiety in extreme sport. Journal of health psychology, 18(4), 477-487.

Buckley, R. (2012). Rush as a key motivation in skilled adventure tourism: Resolving the risk recreation paradox. Tourism Management, 33, 961–970.

Castanier, C., Le Scanff, C., & Woodman, T. (2010). Who takes risks in high-risk sports? A typological personality approach. Research Quarterly for Exercise and Sport, 81, 478–484.

Celsi, R. L., Rose, R. L., & Leigh, T. W. (1993). An exploration of high risk leisure consumption through skydiving. Journal of Consumer Research, 20(1), 1–23.

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

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

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

Heirene, R. M., Shearer, D., Roderique-Davies, G., & Mellalieu, S. D. (2016). Addiction in extreme sports: An exploration of withdrawal states in rock climbers. Journal of Behavioral Addictions, 5(2), 332-341.

Larkin, M. & Griffiths, M.D. (2004). Dangerous sports and recreational drug-use: Rationalising and contextualising risk. Journal of Community and Applied Social Psychology, 14, 215-232.

Monasterio, E., & Mei-Dan, O. (2008). Risk and severity of injury in a population of BASE jumpers. New Zealand Medical Journal, 121, 70–75.

Monasterio, E., Mulder, R., Frampton, C., & Mei-Dan, O. (2012). Personality characteristics of BASE jumpers. Journal of Applied Sport Psychology, 24, 391-400.

Price, I. R., & Bundesen, C. (2005). Emotional changes in skydivers in relation to experience. Personality and Individual Differences, 38, 1203–1211.

Roderique-Davies, G. R. D., Heirene, R. M., Mellalieu, S., & Shearer, D. A. (2018). Development and initial validation of a rock climbing craving questionnaire (RCCQ). Frontiers in Psychology, 9, 204. doi: 10.3389/fpsyg.2018.00204

Willig, C. (2008). A phenomenological investigation of the experience of taking part in extreme sports. Journal of Health Psychology, 13(5), 690-702.

Ride on high: Another look at the psychology (and cycleology) of ‘cycling addiction’

Back in 2012, I wrote an article on cycling addiction for my blog and classed the behaviour as a sub-type of exercise addiction. Recently (June 2016), I was interviewed by Cycling Weekly magazine for an article on addiction to cycling, so I thought it opportune to look at the issue again. Over the last five years or so there has been an increase in the amount of research into exercise addiction (as I have outlined in a number of papers with my Hungarian colleagues Attila Szabo and Zsolt Demetrovics – see ‘Further reading’ below). However, there has still been no empirical research specifically into cycling addiction. In his 1997 book Motivation and Emotion in Sport, Dr. John Kerr speculated that endurance type exercise activities (e.g. running, cycling, swimming, aerobics and weight training) were most often associated with exercise addiction and dependence but this was based more on anecdotal as opposed to scientific evidence.

For the Cycling Weekly article, I was interviewed by Dr. Josephine Perry (who just happed to be both a psychologist and a cyclist). She noted in her article that:

“As a regular cyclist, it’s very likely you take a close interest in performance and have a strong drive to improve coupled with a willingness to push yourself hard in training and racing. Sometimes you probably feel under attack from family or colleagues who question or tease you about your ‘obsessive’ cycling habit. You no doubt retaliate by citing the many benefits of cycling: the brilliant friendships, massive health improvements, toned body and all the places you get to explore on your bike. But do your critics occasionally have a point? Does your relentless drive to improve sometimes go too far and place you in danger of crossing the thin line from dedication into addiction? Addiction to cycling is defined by an incessant internal need to train hard every day without taking the time off that you need to rest and recover — not to mention attend to other commitments in your life. In other words, addiction is defined by harm. You ignore the pleas from family or friends to cut back. Your priorities get rearranged, and nothing is allowed to come between you and your bike. Once this line is crossed, the benefits of cycling begin to diminish. The addicted cyclist feels more aches and pains, becomes prone to physical injuries, regular colds and hidden illnesses”.

In a recent (2016) book chapter, my colleagues and I noted that exercise addiction (irrespective of the sub-type) is a condition in which a regularly exercising person loses control over her or his exercise behaviour, while acting compulsively and exhibiting dependence, resulting in negative consequences in their day-to-day health and/or life. This maladaptive exercise behaviour is characterized by severe withdrawal symptoms when exercise is not possible, similar to both chemical addictions (e.g., alcohol addiction) and other behavioural addictions (e.g., gambling addiction). Based on the scientific evidence, exercise addiction is relatively rare, ranging from 0.3% to 0.5% as noted in the only study published using a representative national sample of the general population that we carried out in Hungary back in 2012 (published in the journal Psychology of Sport and Exercise). Given that exercise addiction (in general) is rare, the prevalence of cycling addiction would therefore be even lower. However, that doesn’t mean it doesn’t exist.

A recent study carried out by Dr. Bernd Zeulner and his colleagues among 1,031 endurance athletes (that included an unspecified number of cyclists) assessed the prevalence of exercise addiction using the Exercise Addiction Inventory (EAI; a scale that I co-developed with my colleagues Attila Szabo and Annabel Terry). The study (published in the journal Advances in Physical Education) found that 2.7% had the potential to develop an exercise addiction and that is higher than the prevalence among the general population.

Another study published in the Journal of Clinical Sport Psychology by Dr. Jason Youngman and Dr. Duncan Simpson examined exercise addiction among 1,285 triathletes (cycling, swimming and running) also using the EAI. The study found that approximately 20% of triathletes were at risk for exercise addiction, and that training for longer distance races puts triathletes at greater risk for exercise addiction than training for shorter races. They also found that as the number of weekly training hours increased, so did a triathlete’s risk for exercise addiction. Despite the lack of empirical evidence specifically on cycling addiction, Dr. Perry also noted in her article that:

“[Addicted cyclists] can also become susceptible to burnout and all that comes with it: decreased performance, low mood, changes in appetite, difficulty sleeping and generally a feeling that the outcomes are not matching the intensity of the effort being put in. For a cycling addict, this loss of form and the feelings of difficulty can be devastating…Other research has found the risks are highest in those exercising over five times a week. With the average amount of training for serious amateur cyclists being around 10 hours a week, they are certainly in the higher-risk category”.

I am not sure which study Dr. Perry is referring to in this quote, but in my interview with her, I noted that from my perspective, any behaviour can be potentially addictive if the reward mechanisms are in place but that we should be cautious about imposing the ‘addiction’ label. I told her that we can’t define whether someone is addicted just by the behaviour that they display. It is all to do with the context of that behaviour in their life. More importantly, it’s is not about the amount of time spent engaging in the behaviour but what impact the behaviour has on them. As I explained:

“A healthy enthusiasm adds to their life. An addiction takes away from it. If you have no dependants and both you and your partner enjoy the sport and there is no conflict, it would not be classed as an addiction. If family conflict becomes a factor, the exercise habit becomes fraught with complications.”

I noted in my previous blog on cycling addiction that one of the traits that appears to be associated with exercise addiction is perfectionism according to a 1990 paper by Dr. Caroline Davis that appeared in the journal Personality and Individual Differences. Research (by Dr. Heather Hasenblaus among others) has also found that extraversion, neuroticism, and agreeableness predict exercise addiction symptoms. I also noted in my interview with Dr. Perry that some people (such as those with Type A personalities) appear to have their risk for exercise addiction built into them. Some cyclists will be those Type-A achievers who are reward-orientated to do the best they can, in whatever they do. If they take up a sport, those personality traits previously used to be successful and focused in other areas such as work go into the new area.

I also noted in my Cycling Weekly interview that there are a number of signs that can help you spot if your attitude towards cycling is unhealthy. The most obvious one is when cycling becomes the most important activity in your life, dominating thinking, feelings and behaviour. If you need to cycle more to get the same mood benefit that you used to, your mood changes significantly and/or you feel physical effects when you can’t cycle, you may also be at risk. If you start to resent your family, job, social life, hobbies or other interests getting in the way of you cycling, you need to consider if you have crossed the line. Those addicted to cycling are more likely to get into debt to fund their habit, become excessively controlling over their eating to regulate weight and competitiveness, and find it hard to balance work, social and family commitments with training.

I was also asked for my views on the treatment of cycling addiction and said that cognitive-behavioural therapy would likely be the most effective (as the addict would be guided to identify goals that motivate them and be helped to find safe and reasonable ways to reach those goals) but that the type of treatment depends on whether the addiction to cycling was primary or secondary. Primary addicts, who are actually addicted because they love their sport, will find it is very hard to give up. Telling them they can’t continue will be stressful in itself. Secondary addicts may be trying to lose weight or to escape negative, unpleasant feelings or difficulties in their lives, using cycling to control their thoughts. These cyclists are using exercise as a coping mechanism. The key here is finding out why they are doing it to such an extent in the first place. Most will find their addiction is symptomatic of something else.

After interviewing me about whether cycling can be potentially addictive, Dr. Perry summed up my own views arguably better than I could have done it myself:

“[Cycling addiction] is not just about how many hours you are doing on the bike, how much you love your riding, or how many bikes you have; what matters is the impact on your life. If your work and family life allows it without conflict, and you’re not feeling over-stressed or over-tired, then your commitment to cycling is just that – a commitment. If you are suffering from continual injuries and not recovering fully, have found yourself feeling burnt out, dips in mood, feel obliged to miss family or social events for training, resulting in arguments, then you need to ask yourself seriously: am I addicted?”

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

Further reading

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

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Kökönyei, G., Urbán, R. and Demetrovics, Z. (2014). Exercise addiction – the emergence of a new disorder. Australasian Epidemiologist, 21(2), 36-40.

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2011). Exercise addiction: Symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Davis, C. (1990). Weight and diet preoccupation and addictiveness: The role of exercise. Personality and Individual Differences, 11, 823-827.

Freimuth, M., Moniz, S., & Kim, S.R. (2011). Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. International Journal of Environmental Research and Public Health, 8(10), 4069-4081.

Griffiths, M. D. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), e30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hausenblas, H.A., & Giacobbi, P.R. (2004). Relationship between exercise dependence symptoms and personality. Personality and Individual differences, 36(6), 1265-1273.

Kerr, J. H. (1997) Motivation and Emotion in Sport: Reversal Theory. Hove: Psychology Press.

Kerr, J.H., Lindner, K.J. & Blaydon, M. (2007). Exercise Dependence. Oxford: Rutledge.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

Perry, J. (2016). Are you addicted to cycling? Cycling Weekly, July 21. Located at: http://www.cyclingweekly.co.uk/fitness/training/are-you-addicted-to-cycling-261852

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

Szabo, A., Griffiths, M.D. & Demetrovics, Z. (2016). Exercise addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse (Vol. 3) (pp. 984-992). London: Academic Press.

Terry, A., Szabo, A., & Griffiths, M. D. (2004). The exercise addiction inventory: A new brief screening tool. Addiction Research and Theory, 12, 489-499.

Youngman, J., & Simpson, D. (2014). Risk for exercise addiction: A comparison of triathletes training for sprint-, Olympic-, half-Ironman-, and Ironman-distance triathlons. Journal of Clinical Sport Psychology, 8, 19-37.

Zeulner, B., Ziemainz, H., Beyer, C., Hammon, M., & Janka, R. (2016). Disordered Eating and Exercise Dependence in Endurance Athletes. Advances in Physical Education, 6(2), 76.

Myth world: Addictive personality does not exist

(Please note: This article is a slightly expanded and original version of an article that was first published in The Conversation).

“Life is a series of addictions and without them we die”. This is my favourite quote in the academic addiction literature and was made back in 1990 in the British Journal of Addiction by Professor Isaac Marks. This deliberately provocative and controversial statement was made to stimulate debate about whether excessive and potentially problematic activities such as gambling, sex and work can really be classed as genuine addictive behaviours. Many of us might say to ourselves that we are ‘addicted’ to tea or coffee, our work, or know others who we might describe as having addictions watching the television or using pornography. But is this really true?

The issue all comes down to how addiction is defined in the first place as many of us in the field disagree on what the core components of addiction are. Many would argue that the word ‘addiction’ or ‘addictive’ is used so much in everyday circumstances that word has become meaningless. For instance, saying that a book is an ‘addictive read’ or that a specific television series is ‘addictive viewing’ renders the word useless in a clinical setting. Here the word ‘addictive’ is arguably used in a positive way and as such it devalues the real meaning of the word.

The question I get asked most – particularly by the broadcast media – is what is the difference between a healthy excessive enthusiasm and an addiction and my response is simple – a healthy excessive enthusiasm adds to life whereas an addiction takes away from it. I also believe that to be classed as an addiction, any such behaviour should comprise a number of key components including overriding preoccupation with the behaviour, conflict with other activities and relationships, withdrawal symptoms when unable to engage in the activity, an increase in the behaviour over time (tolerance), and use of the behaviour to alter mood state. Other consequences such as feeling out of control with the behaviour and cravings for the behaviour are often present. If all these signs and symptoms are present I would call the behaviour a true addiction. However, that hasn’t stopped others accusing me of ‘watering down’ the concept of addiction.

A few years ago, Dr. Steve Sussman, Nadra Lisha and I published a large and comprehensive review in the journal Evaluation and the Health Professions examining the co-relationship between eleven different potentially addictive behaviours reported in the academic literature (smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work, and shopping). We examined the data from 83 large-scale studies and reported an overall 12-month prevalence of an addiction among U.S. adults varies from 15% to 61%. We also reported it plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period, and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors. In short – and with many caveats – our paper argued that at any one time almost half the US population are addicted to one or more behaviours.

There is a lot of scientific literature showing that having one addiction increases the propensity to have other co-occurring addictions. For instance, in my own research I have come across alcoholic pathological gamblers and we can all probably think of individuals that we might describe as caffeine-addicted workaholics. It is also very common for individuals that give up one addiction to replace it with another (which we psychologists call ‘reciprocity’). This is easily understandable as when an individual gives up one addiction it leaves a large hole in the waking lives (often referred to as the ‘void’) and often the only activities that can fill the void and give similar experiences are other potentially addictive behaviours. This has led many people to describe such people as having an ‘addictive personality’.

While there are many pre-disposing factors for addictive behaviour including genetic factors and psychological personality traits such as high neuroticism (anxious, unhappy, prone to negative emotions) and low conscientiousness (impulsive, careless, disorganised), I would argue that ‘addictive personality’ is a complete myth. Even though there is good scientific evidence that most people with addictions are highly neurotic, neuroticism in itself is not predictive of addiction (for instance, there are individuals who are highly neurotic but are not addicted to anything so neuroticism is not predictive of addiction). In short, there is no good evidence that there is a specific personality trait (or set of traits) that is predictive of addiction and addiction alone.

Doing something habitually or excessively does not necessarily make it problematic. While there are many behaviours such as drinking too much caffeine or watching too much television that could theoretically be described as addictive behaviours, they are more likely to be habitual behaviours that are important in an individual’s life but actually cause little or no problems. As such, these behaviours should not be described as an addiction unless the behaviour causes significant psychological and/or physiological effects in their day-to-day lives.

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

Further reading

Andreassen, C.S., Griffiths, M.D., Gjertsen, S.R., Krossbakken, E., Kvan, S., & Ståle Pallesen, S. (2013). The relationships between behavioral addictions and the five-factor model of personality. Journal of Behavioral Addictions, 2, 90-99.

Goodman, A. (2008). Neurobiology of addiction: An integrative review. Biochemical Pharmacology, 75(1), 266-322.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

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

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. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.

Kerr, J. S. (1996). Two myths of addiction: the addictive personality and the issue of free choice. Human Psychopharmacology: Clinical and Experimental, 11(S1), S9-S13.

Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136(5), 768-821.

Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.

Marks, I. (1990). Behaviour (non-chemical) addictions. British Journal of Addiction, 85, 1389-1394.

Nakken, C. (2009). The addictive personality: Understanding the addictive process and compulsive behavior. Hazelden, Minnesota: Hazelden Publishing.

Nathan, P. E. (1988). The addictive personality is the behavior of the addict. Journal of Consulting and Clinical Psychology, 56(2), 183-188.

Naming desire: A personal look at my new job title

Back in 2002, I was incredibly proud when I became one of the youngest full Professors in the UK when I was bestowed the title of Professor of Gambling Studies based on my research contribitions to the gambling studies field. Anyone that has followed my career over the last decade (or this blog over the last four years) will no doubt have realised that my research interests and expertise include a lot more than gambling.

Although I still publish a lot of papers on gambling (12 to 17 papers per calendar year; see Appendix 1 below) I have carried out more and more research into non-gambling addictions and over the last six years (2010-2015) my refereed journal outputs on gambling have only constituted one-third of all my refereed journal outputs (32%) (see Appendix 1 and Figure 1).

Screen Shot 2015-10-31 at 13.15.27

The overwhelming majority of my published refereed papers since January 2010 (n=246; 88%) concern behavioural addictions (i.e., gambling addiction, videogame addiction, internet addiction, work addiction, sex addiction, exercise addiction, shopping addiction, dancing addiction, etc.). If gambling addiction is removed from these papers, this still leaves 56% of all my papers during the 2010-2015 period concerning other behavioural addictions (n=158). The remainder of my refereed journal papers (34 papers; 12%) mainly concern the topic of mindfulness carried out with my colleagues Edo Shonin and William Van Gordon. Even my three books in the 2010-2105 timeframe have been on three totally separate topics (i.e., problem gambling, internet addiction and mindfulness). Of my 71 book chapters in this 2010-2015 period, 22 have been on gambling addiction, 41 have been on other behavioural addictions, and 8 have concerned other topics (see Figure 2). In the ‘Further reading’ section below is some of the papers that I have published this year and even a quick glance will highlight that gambling papers are in the minority.

It is also worth noting that I am one of the most highly cited academics in the UK (soemthig else that I am very proud of) and a quick look at my Google Scholar citations profile (currently over 24,500 citations as of October 31, 2015) that of my top ten most highly cited papers, only one is on gambling adiction and the other nine concern my papers on videogame addiction and internet addiction.

Basically, my job title didn’t reflect what I was actually doing on the research front. And this is the very argument I put to my employer (Nottingham Trent University) a number of weeks ago. As far as I am aware, I am the first professor at NTU to ever ask for my title to be changed but last week I was informed by my line manager that the university was convinced by the case I put forward and from now on I will be Professor of Behavioural Addiction.

This new title change has pleased me greatly and of course subsumes the vast majority of the research that I am doing (including my research into gambling addiction). I don’t think I will ever stop carrying out research in the gambling field but my new job title will stop me feeling guilty about working in non-gambling areas. It may also stop some of few abusive emails I get regarding my blogs (saying in very colourful language that I should stop writing about other behavioural addictions and sexual paraphilias and “write about what I get paid to do”). Firstly, I would point out to these individuals that I don’t get paid to write my personal blog and even if I did, I write all my blogs in my spare time.

If you’ve read this far, then thank you. I promise normal service will be resumed in my next blog when it will be about something other than myself.

Appendix 1: Summary statistics of my refereed journal papers (January 1, 2010 to October 20, 2015)

  • 2010: Gambling papers (n=17); Behavioural addiction papers (n=19); Other papers (n=1)
  • 2011: Gambling papers (n=15); Behavioural addiction papers (n=15); Other papers (n=2)
  • 2012: Gambling papers (n=10); Behavioural addiction papers (n=28); Other papers (n=3)
  • 2013: Gambling papers (n=12); Behavioural addiction papers (n=23); Other papers (n=4)
  • 2014: Gambling papers (n=13); Behavioural addiction papers (n=33); Other papers (n=13)
  • 2015: Gambling papers (n=13); Behavioural addiction papers (n=27); Other papers (n=7)
  • In press: Gambling papers (n=8); Behavioural addiction papers (n=13); Other papers (n=4)

 

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

Further reading (some recent papers)

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.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

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

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

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Canale, N. Santinello, M. & Griffiths, M.D. (2015). Validation of the Reasons for Gambling Questionnaire (RGQ) in a British population survey. Addictive Behaviors, 45, 276-280.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). Trait urgency and gambling problems in young people: the role of decision-making processes. Addictive Behaviors, 46, 39-44.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits. Psychology of Addictive Behaviors, 29, 813–823.

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Dhuffar, M. & Pontes, H.M. & Griffiths, M.D. (2015). Dysphoric mood states and consequences of sexual behaviours as predictors of hypersexual behaviours in university students: An exploratory study. Journal of Behavioural Addictions, 4, 181–188.

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Griffiths, M.D. (2015). Problematic technology use during adolescence: Why don’t teenagers seek treatment? Education and Health, 33, 6-9.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Hussain, Z., Williams, G. & Griffiths, M.D. (2015). An exploratory study of the association between online gaming addiction and enjoyment motivations for playing massively multiplayer online role-playing games. Computers in Human Behavior, 50, 221–230.

Karanika-Murray, M., Pontes, H.M., Griffiths, M.D. & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science and Medicine, 139, 100-106.

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Urbán, R., Griffiths, M.D., Ágoston, C., Nagygyörgy, K., Kökönyei, G. & Demetrovics, Z. (2015). Psychiatric symptoms and problematic online gaming: The mediating effect of gaming motivation. Journal of Medical Internet Research, 17(4) :e88.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

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

Pontes, H.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.

Quinones, C. & Mark D. Griffiths (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Whirled piece: Dancing as an addiction

In previous blogs I have examined various (admittedly extreme) aspects of dancing including people that are sexually aroused by dancing (choreophilia), dancing as a form of frottuerism, people that are addicted to dancing (in this case, the Argentine tango), and people who have developed medical complaints as a result of dancing (‘breaker’s neck’ caused by break dancing). However, over the last few months I have been a co-author on two dance-related research papers with my research colleagues in Hungary (led by Aniko Maraz). The first one (published in the journal PLoS ONE) was about the development and psychometric validation of the ‘Dancing Motives Inventory’ (DMI). The second one (also published in PLoS ONE) was a study of dance addiction (and which I will describe in more detail below).

I’m sure many of you reading this will think that dancing is a somewhat trivial area to be carrying out scientific research. However, research has shown that dancing can have substantial benefits for physical and mental health such as decreased depression and anxiety, and increased physical and psychological wellbeing. After we developed the DMI, we realised that very little known about the psychological underpinnings of excessive dancing, and whether in extreme cases, dancing could be classed as an addictive behaviour. Given the lack of empirical research in dance addiction, we conceptualized dance addiction to be akin to exercise addiction. For example, a study published in the journal Perceptual and Motor Skills led by Dr. Edgar Pierce reported that dancers scored higher on the Exercise Addiction Scale compared to endurance and non-endurance athletes. Added to this, both exercise and dancing require stamina and physical fitness, and for this reason, dance is often classified as a form of exercise.

Over the last 20 years I have published many papers on exercise addiction (see ‘Further reading’ below) so there is no reason why dance addiction couldn’t theoretically exist (in fact, it could be argued that dance addiction – if it exists – is a sub-type of exercise addiction). There are also a handful of studies that have examined excessive dancing and whether it can be addictive to a small minority. A study by Edgar Pierce and Myra Daleng (again in Perceptual and Motor Skills) conducted a study with 10 elite ballet dancers and found that dancers rated thinner bodies as ideal and significantly more desirable than their actual body image despite being in the ‘ideal’ BMI range. The study also found that dancers often continue to dance despite discomfort, “because of the embedded subculture in dance that embraces injury, pain, and tolerance”. In a more recent study in the Journal of Behavioral Addictions (and which I reported at length in a previous blog), Dr. Remi Targhetta and colleagues assessed addiction to the Argentine tango. They found that almost half of their participants (45%) met the DSM-IV criteria of abuse, although a substantially lower prevalence rate (7%) was found when using more conservative criteria.

In our recently published study, we proposed that excessive social dancing would be associated with detriments to mental health. More specifically, we aimed to (i) identify subgroups of dancers regarding addiction tendencies, (ii) explore which factors account for the elevated risk of dance addiction, and (iii) explore the motivations underlying excessive dancing.

Our sample included 447 salsa and ballroom dancers (32% male and 68% female, with an average age of 33 years) who danced recreationally at least once a week. To assess ‘dance addiction’ we created the ‘Dance Addiction Inventory’ modified from the Exercise Addiction Inventory (that I co-developed back in 2004) in which we simply replaced the word ‘exercise’ with the word ‘dance’. We also assessed the dancers’ general mental health, borderline personality disorder, eating disorder symptoms, and dance motives.

As far as we are aware, our study is the first to explore the psychopathology and motivation behind dance addiction. Based on my criteria of addiction, five distinct types of dancers were identified. Only two of these types danced excessively. About one-quarter of our sample reported high values on all criteria of addiction but they reported no conflict with the social environment. However, 11% of dancers (and what we termed the ‘high risk’ group) scored high on all addiction symptoms and experienced conflict in their life as a consequence of their excessive dancing.

Our study also found that dance addiction was associated with mild psychopathology, especially with elevated number of eating disorder symptoms and (to a lesser extent) borderline personality traits (something which has also been found in research examining exercise addiction). Perhaps unsurprisingly, escapism (and to a lesser extent mood enhancement) was an especially strong indicator of dance addiction. I say ‘unsurprisingly’ because escapism has already been much reported in other types of behavioural addiction such as gambling and video gaming (including a lot of my own research). Here, escapism as a motivational factor refers to dancing in order to avoid feeling empty or as a mechanism to deal with everyday problems. Based on our findings, we believe that to a minority of individuals appear to be addicted to dancing and that it may be being used be a maladaptive coping mechanism.

Based on what we know in the exercise addiction literature, we proposed that future studies should also assess whether eating disorder is primary or secondary to dance addiction (i.e., whether the purpose of excessive dancing is weight-control and/or the motivation to perform leads to disturbances in eating patterns). I should also point out that although we found that distress was correlated with dance addiction, the association disappeared when other measures were added to the regression model. This may indicate that distress is not directly associated with problematic dancing and that it may arise from other problematic factors such as having an eating disorder.

Given the lack of research in the field, other studies are needed to confirm or refute the findings of our study. Given that dancing is a social activity, social conflicts may not arise when the person has only fellow dancers as partners or friends – therefore, the risky behaviour may remain somewhat hidden. Another question that could be examined is whether there is any difference between amateur and professional dancers in terms of addiction tendency (although among professional dancers there may be a debate about whether their behaviour is dancing addiction or ‘workaholism’). Also, we don’t know whether our findings can be extended to other dance genres (as we only surveyed ballroom and salsa dancers)

I would just like to end by saying that dancing is very clearly a healthy activity for the majority of individuals. However, our study does seem to suggest that excessive dancing may have problematic and/or harmful effects for a small minority. Although we couldn’t establish causality, dance addiction appears to have the potential to be associated with mild psychopathology.

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

Additional input: Aniko Maraz, Róbert Urbán and Zsolt Demetrovics.

Further reading

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

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Berczik, K., Szabó, A., Griffiths, M.D., Kurimay, T., Kun, B. & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Griffiths, M.D., Szabo, A. & Terry, A. (2005). The Exercise Addiction Inventory: A quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, 30-31.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Kurimay, T., Griffiths, M.D., Berczik, K., & Demetrovics, Z. (2013). Exercise addiction: The dark side of sports and exercise. In Baron, D., Reardon, C. & Baron, S.H., Contemporary Issues in Sports Psychiatry: A Global Perspective (pp.33-43). Chichester: Wiley.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Pierce, E.F. & Daleng, M.L. (1998) Distortion of body image among elite female dancers. Perceptual and Motor Skills, 87, 769-770.

Pierce, E.F., Daleng, M.L. & McGowan, R.W. (1993) Scores on exercise dependence among dancers. Perceptual and Motor Skills, 76, 531-535.

Ramirez, B., Masella, P.A., Fiscina, B., Lala, V.R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

In dependence days: A brief overview of behavioural addictions

Please note: A version of this blog first appeared on addiction.com

Conceptualizing addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. Therefore it is perhaps unsurprising that most official definitions concentrate on drug ingestion. Despite such definitions, there is now a growing movement that views a number of behaviours as potentially addictive including those that do not involve the ingestion of a drug. These include behaviours diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioural – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

  • Salience – This occurs when the activity 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 engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity 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’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

In May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders as had been the case since 1980 when it was first included in the DSM-III). Although most of us in the field had been conceptualizing extreme problem gambling as an addiction for many years, this was arguably the first time that an established medical body had described it as such.

There had also been debates about whether or not ‘Internet Addiction Disorder’ should have been included in the DSM-5. As a result of these debates, the Substance Use Disorder Work Group recommended that the DSM-5 include ‘Internet Gaming Disorder’ [IGD] in Section III (“Emerging Measures and Models”) as an area that required further research before possible inclusion in future editions of the DSM. To be included in its own right in the next edition, research will have to establish the defining features of IGD, obtain cross-cultural data on reliability and validity of specific diagnostic criteria, determine prevalence rates in representative epidemiological samples in countries around the world, and examine its associated biological features. Other than gambling and gaming, no other behaviour (e.g., sex, work, exercise, etc.) has yet to be classified as a genuine addiction by established medical and/or psychiatric organizations.

In one of the most comprehensive reviews of chemical and behavioural addictions, Dr. Steve Sussman, Nadra Lisha and myself examined all the prevalence literature relating to 11 different potentially addictive behaviours. We reported overall prevalence rates of addictions to cigarette smoking (15%), drinking alcohol (10%), illicit drug taking (5%), eating (2%), gambling (2%), internet use (2%), love (3%), sex (3%), exercise (3%), work (10%), and shopping (6%). However, most of the prevalence data relating to behavioural addictions (with the exception of gambling) did not have prevalence data from nationally representative samples and therefore relied on small and/or self-selected samples.

Addiction is an incredibly complex behaviour and always result from an interaction and interplay between many factors including the person’s biological and/or genetic predisposition, their psychological constitution (personality factors, unconscious motivations, attitudes, expectations, beliefs, etc.), their social environment (i.e. situational characteristics such as accessibility and availability of the activity, the advertising of the activity) and the nature of the activity itself (i.e. structural characteristics such as the size of the stake or jackpot in gambling). This ‘global’ view of addiction highlights the interconnected processes and integration between individual differences (i.e. personal vulnerability factors), situational characteristics, structural characteristics, and the resulting addictive behaviour.

There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioural addictions (e.g. personality traits, biological and genetic predispositions, unconscious motivations, learning and conditioning effects, thoughts, beliefs, and attitudes), although some factors are more personal (e.g. financial motivation and economic pressures in the case of gambling addiction). However, there are also some key risk factors that are highly associated with developing almost any (chemical or behavioural) addiction such as having a family history of addiction, having co-morbid psychological problems, and having a lack of family involvement and supervision. Psychosocial factors such as low self-esteem, loneliness, depression, high anxiety, and stress all appear to be common among those with behavioural addictions.

This article briefly demonstrates that behavioural addictions are a part of a biopsychosocial process and not just restricted to drug-ingested (chemical) behaviours. Evidence is growing that excessive behaviours of all types do seem to have many commonalities and this may reflect a common etiology of addictive behaviour. Such commonalities may have implications not only for treatment of such behaviours but also for how the general public perceive such behaviours.

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

Further reading

Berczik, K., Griffiths, M.D., Szabó, A., Kurimay, T., Urban, R. & Demetrovics, Z. (2014). Exercise addiction. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.317-342). New York: Elsevier.

Demetrovics, Z. & Griffiths, M.D. (2012). Behavioral addictions: Past, present and future. Journal of Behavioral Addictions, 1, 1-2.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

Griffiths, M.D. (2009). Gambling addictions. In A. Browne-Miller (Ed.), The Praeger International Collection on Addictions: Behavioral Addictions from Concept to Compulsion (pp. 235-257). Westport, CT: Praeger.

Griffiths, M.D. (2010). Addicted to sex? Psychology Review, 16(1), 27-29

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Transgressive Culture, 1(1), 7-28.

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

Griffiths, M.D., Kuss, D.J. & Demetrovics, Z. (2014). Social networking addiction: An overview of preliminary findings. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.119-141). New York: Elsevier.

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

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.

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.

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.

Let’s get physical: Exercise addiction (revisited)

At present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction. In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Exercise addiction has been conceptualised as a behavioural addiction. The symptoms and consequences of exercise addiction have often been characterised by six common components of addiction: salience, mood modification, tolerance, withdrawal symptoms, personal conflict, and relapse.

For some people, exercise addiction is a primary problem in the person’s life whereas in others it can be a secondary problem as a consequence of other psychological dysfunctions (like eating disorders such as anorexia nervosa). In the former case, the dysfunction is considered as primary exercise addiction, while in the latter case it is termed as secondary exercise addiction because it co-occurs with another dysfunction. The differentiating feature between the two is that in primary exercise addiction the objective is the exercise itself, whereas in secondary exercise addiction the objective is weight loss, where excessive exercise is one of the primary means in achieving the desired objective.

The incentive or motive for fulfilling planned exercise is an important distinguishing characteristic between addicted and nonaddicted exercisers. The reason people exercise is often for an intangible reward such as feeling in shape, looking good, being with friends, staying healthy, building muscles, losing weight, etc. The personal experience of the anticipated reward reinforces and strengthens the exercise behaviour. Committed exercisers maintain their exercise for benefiting or gaining from their activity and thus, their behaviour is motivated via positive reinforcement. However, empirical research has demonstrated that addicted exercisers have to exercise in order to avoid negative feelings or withdrawal. The individual’s exercise may become a chore that has to be fulfilled, or otherwise an unwanted event would occur (such as the inability to cope with stress, or gaining weight, becoming moody, etc.). Every time a person undertakes behaviour to avoid something negative, bad, and/or unpleasant, the motive behind that behaviour acts as a negative reinforcement. In these situations, the person feels they have to do it rather than wanting to do it.

Mood modification is a key factor among the symptoms of exercise addiction and suggests there is a self-medication aspect of exercise that facilitates the distinction between normal and abnormal exercise. Addicts do not simply exercise to experience the joy of it, but rather to escape negative, unpleasant feelings and everyday difficulties.

The Exercise Addiction Inventory is one of the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of its brevity and excellent psychometric properties (i.e., reliability and validity). The EAI comprises only six statements, each corresponding to one of the symptoms in the ’components’ model of addiction. Each statement is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The EAI cut-off score for individuals considered at-risk of exercise addiction is 24 out of 30. To date, the only nationally representative study examining exercise addiction is a study that I co-authored with some Hungarian colleagues. We surveyed over 2,700 Hungarian adults aged 18–64 years and assessed exercise addiction using the EAI. Results showed that the proportion of the people at risk for exercise addiction was 0.5%.

There are numerous theories that deal with both the causes of exercise addiction and the process and mechanisms of its development and maintenance. A significant number of psychological theories are based on learning theory or the cognitive psychology approach. According to the theory of functioning, both positive reinforcers (e.g., a feeling of euphoria following exercise or muscle growth from exercise) and negative reinforcers (e.g. an end to unpleasant feelings through exercise or avoidance of the presumed negative effect of missed exercise) may lie behind the development and maintenance of exercise addiction which, according to the fundamental principles of learning theory, may contribute to the establishment of compulsive and addictive exercise that may be viewed as maladaptive.

One of my research colleagues, Dr. Attila Szabo stresses the role of cognitive appraisal mechanisms in the development of the vicious cycle that leads to excessive exercise. The process starts when the habitual exerciser uses exercise as a means of coping with stress, and the affected individual learns to depend on exercise at times of stress. The addicted exerciser is then trapped in a vicious cycle of needing increased amounts of exercise to deal with the consistently increasing life stress, part of which is caused by exercise itself.

It also appears that the issue of self-assessment represents a further significant factor among the psychological factors in the sense that during exercise, the physical strength experienced through exercise in a person dissatisfied with his or her body or body image contributes to the formation of a more positive self-image and self-assessment. It has also been shown that exercise activities (such as weightlifting) have a positive effect on body image and self-esteem both in men and in women. Perfectionism, obsessive-compulsive functioning, and heightened anxiety have also been claimed to be determining factors in exercise addiction.

The public promotion of healthy and appropriate exercise patterns may reduce the incidence of exercise addiction. It is important in public health programs and campaigns to (i) stress the healthy nature of regular exercise and (ii) communicate the message that exercise when taken to excess can be potentially harmful. It is important to raise awareness of potential harm within the population of regular exercisers. Some psychologists claim that individuals with exercise addiction have a poor understanding of the negative health consequences of excessive exercising, of the mechanism of exercise adaptation, and the need for rest between exercise sessions. The use of education may be an effective step in the prevention and treatment of exercise addiction.

As with other addictive disorders, the environment of regular exercisers also plays a significant role in recognising this condition early. In more severe cases psychotherapeutic interventions may be needed. When treating exercise addiction, abstinence from exercise may not be a required and/or realistic goal, because exercise has many benefits for health and no one would advocate doing no exercise. Therefore, the typical treatment goal would more likely be be to return to moderate and controlled exercise. In some cases, a different form of exercise may be recommended.

CASE STUDY

Joanna is a 25-year old student, well-educated female, from a stable family background, who realized that she had a problem surrounding exercise, and more specifically the martial art Jiu-Jitsu. Here, Joanna’s behavior is described in terms of the main components of addiction:

  • Salience: Jiu-Jitsu is the most important activity in Joanna’s life. Even when not actually engaged in the activity, she is thinking about the next training session or competition. She estimates that she spends approximately six hours a day (and sometimes much more) involved in training (e.g., weight training, jogging, general exercise, etc.).
  • Tolerance: Joanna started Jiu-Jitsu at an evening class once a week during her teenage years and built up slowly over a period of about five years. She now exercises every single day, and the lengths of the sessions have become longer and longer (suggesting tolerance).
  • Withdrawal: Joanna claims she becomes highly agitated and irritable if she is unable to exercise. She claims she also gets headaches and feels nauseous if she goes for more than a day without training or has to miss a scheduled session.
  • Mood modification: Joanna experiences mood changes in a number of ways. She feels very high and ‘buzzed up’ if she has done well in a Jiu-Jitsu competition (especially so if she wins). She also feels high if she has trained hard and for a long time.
  • Conflict: Joanna’s relationship with her long-term partner ended as a result of her exercise. She claimed she never spent much time with him and was not even bothered about their break-up. Her university work suffered because of the lack of time and concentration.
  • Loss of control: Joanna claims she cannot stop herself engaging in exercise when she “gets the urge”. Once she has started, she has to do a minimum of a few hours of exercise.
  • Relapse: Joanna has continually tried to stop and/or cut down but claims she cannot. She becomes highly anxious if she is unable to engage in exercise and then has to go out and train to make herself feel better. She is well aware that exercise has taken over her life but feels powerless to stop it.
  • Negative consequences: Joanna spends money beyond her means to maintain her exercising habit (e.g., on entrance fees for weight training, swimming, entrance fees enter Jiu-Jitsu tournaments across the country, etc.). She has resorted to socially unacceptable means (e.g., stealing) in order to get money to fund herself

In short, exercise is the most important thing in Joana’s life, and the number of hours engaged in physical activity per week has increased substantially over a five-year period. She displays withdrawal symptoms when she does not exercise, and experiences euphoric experiences related to various aspects of her exercising (e.g., training hard, winning competitions, etc.). She experiences conflict over exercise in many areas of her life and acknowledges she has a problem. Furthermore, she has lost friends, her relationship has broken down, her academic work has suffered, and she has considerable debt.

Note: An expanded version of this article was first published by Rehabs.com

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

Further reading

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

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.

Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.

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.

Szabo, A. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.

Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.

Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.

Winning runs? Another look at exercise addiction

Research appears to indicate that at times of psychological and/or emotional hardship, some habitual exercisers engage in such activity as a form of escape. The reliance on exercise as a means of coping with adversity has the potential become obsessive as well as compulsive. Associated with increased tolerance, over-exercising may lead to physical injuries, and (in extreme cases) irreversible health consequences, and mortality. Over-exercising to the point where a person loses control over the exercise routine has been termed ‘exercise addiction’ or ‘exercise dependence’. Due to the multidisciplinary nature of the literature regarding problematic exercise, different screening instruments have been formulated to assess the problem. In a 2013 issue of the journal Psychology of Sport and Exercise, I and a team of Hungarian researchers published the first ever national study of exercise addiction, and compared two different screening instruments (i.e., the Exercise Addiction Inventory [EAI] and the Exercise Dependence Scale [EDS]).

We made the assumption that these two instruments attempt to assess the same phenomenon. We also published a comprehensive review examining the literature on problematic exercise in a 2012 issue of Substance Use and Misuse and came to the conclusion that the most appropriate term to use is ‘exercise addiction’ because it incorporates both ‘dependence’ and ‘compulsion’. However, most researchers in the field use the terms ‘exercise addiction’, ‘exercise dependence’ and ‘compulsive exercise’ to mean the same thing.

These six core components of addictive behaviour that I outlined in my very first blog served the theoretical foundation for the Exercise Addiction Inventory (EAI). The EAI is a short, psychometrically validated questionnaire that comprises only six statements, each corresponding to one of the symptoms in the ‘components’ model of addiction. However, the cut-off points for exercise addiction were never tested psychometrically. The Exercise Dependence Scale (EDS) was based on the Diagnostic and Statistical Manual of Mental Disorder-IV criteria for substance dependence. The higher the score, the higher is the risk for addiction.

The EAI and the EDS are perhaps the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of their superior psychometric properties in contrast to other instruments, and secondarily because of their theoretical underpinning. However, until our recently published study, these two tools had never been used in a nationally representative study. We assessed exercise addiction within the framework of the National Survey on Addiction Problems in Hungary (NSAPH).

The final sample comprised 2,170 people, stratified according to geographical location, degree of urbanization, and age. Those in this sample who engaged in regular exercise at least on a weekly basis (17.5%) were invited to complete the EAI and the EDS and comprised 474 participants (270 males and 204 females). In line with our assumptions, there was a high correlation between the two exercise addiction/dependence measures. On the basis of results we obtained, we reported that 0.3-0.5% of population is involved in addictive exercise (and equates to 1.9% to 3.2% of weekly regular exercisers).

As mentioned above, our study is the first national study ever to assess the prevalence of exercise addiction in a representative national sample and therefore there are no studies to compare our national findings of the study to. Our study provides primary benchmark data that subsequent national studies will need to be compared to. It is also the first ever study to compare the psychometric properties of (arguably) the two most widely used screening instruments that assess exercise dependence/addiction.

Based on the results of our study, it appears that both of the tools we examined (i.e., EAI and EDS) can reliably be applied in the future for both scientific research in the exercise addiction field, and as a screening instrument in non-research settings. For instance, the short, 6-item EAI could be used as a screening instrument in empirical surveys as a way of combating questionnaire fatigue. It could also be used as a ‘quick and easy’ tool that can be used by health practitioners (such as GPs with their patients) in screening for exercise addiction. The EDS also appears to be suitable for acquiring a more detailed and greater empirical insight to the problem in future studies.

However, there were also a number of limitations to our study. Owing to the sampling method, it was financially impractical to use observational data on physical activity and/or face-to-face clinical interviewing, and therefore we had to base our analysis solely on the basis of self-reports. Self-report data is also prone to the weaknesses of survey methodologies more generally including factors such as recall bias and social desirability. Another limitation was the cross-sectional nature of the dataset, therefore the causality inferences are limited, although further research may identify trends in exercise behaviours and provide models to determine the changes in exercise addiction. Another important question is the generalizability of these results to other countries. However, this question cannot be answered in a reliable way. Though the prevalence of regular exercise is lower in Hungary than in most of the other countries of the European Union, this result, in and of itself, does not necessarily mean that prevalence of excessive exercise is lower as well. It is also possible that though the prevalence of regular exercise is lower than in other countries, prevalence of exercise addiction among the exercisers is higher.

Our results indicate that while optimal regular exercising is a key component of preserving and improving physical and mental health, in case of a small proportion of the population, excessive exercise can generate significant problems. Both the EDS and EAI are adequate screening solutions to assessing exercise dependence/addiction within target populations. While the seven-factor EDS might give a more complex picture on the problem, the short, 6-item EAI has the added advantage of providing anyone who uses the instrument with an estimation of problems with exercise very quickly. Nevertheless, clinical validation of these assessment tools needs to be further targeted and scrutinized by future research.

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

Further reading

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

Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.

Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.

Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.

Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.

Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.

Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.

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