Category Archives: Psychiatry
Earlier this year, the World Health Organisation announced that ‘Gaming Disorder’ (GD) was to be officially been included in the latest (eleventh) edition of the International Classification of Diseases (ICD-11). The announcement received worldwide media coverage alongside many debates as to whether its inclusion was justified based on the scientific evidence. The extensive media coverage raised many questions but also appeared to give rise to a number of myths. In this blog, I address these myths in the British context but some of these myths also have resonance outside the UK.
Myth 1 – Gaming Disorder equates to gaming addiction. Almost all of the worldwide press coverage for GD in June 2018 was equated with gaming addiction. However, the World Health Organization (WHO) does not describe GD as an addiction and the WHO criteria for GD do not include criteria that I believe are core to being genuine addictions (such as tolerance and withdrawal symptoms). Confusingly, the criteria for Internet Gaming Disorder (IGD) in the latest (fifth) edition of the Diagnostic Manual of Mental Disorders (DSM-5) does include all my core criteria of addiction. However, to be diagnosed with IGD, an individual does not necessarily have to endorse all the core addiction criteria. In short, all genuine gaming addicts are likely to be diagnosed as having GD and/or IGD but not all those with GD and/or IGD are necessarily gaming addicts.
Myth 2 – Gaming has many benefits so should not be classed as a disorder as it will create a ‘moral panic’: Predictably, the videogame industry has not welcomed the WHO’s decision to include GD in the ICD-11 and issued a statement to say gaming has many personal benefits and that GD will create moral panic and ‘abuse of diagnosis’. None of us in the field dispute the fact that gaming has many benefits but many other activities such as work, sex, and exercise can be disordered and addictive for a small minority, and is not a good basis for denying the existence of GD. The videogame industry also claims the empirical basis for GD is highly contested but then ironically uses non-empirical claims (i.e., that the introduction of GD will cause a moral panic and lead to diagnostic abuse by practitioners) as a core argument for why GD should not exist.
Myth 3 – Gaming Disorder is associated with other comorbidities so is not a separate disorder. In coverage concerning GD, those denying the existence of GD sometimes resort to the argument that problematic gaming is typically comorbid with other mental health conditions (e.g., depression, anxiety disorders, etc.) and therefore should not be classed as a separate disorder. However, such an argument is not applied (for instance) to those with alcohol use disorder or gambling disorder which are known to be associated with other comorbidities. In fact, we recently published some case studies in the International Journal of Mental Health and Addiction highlighting those attending treatment for GD included individuals both with and without underlying comorbidities. Consequently, diagnosis of disorders should be based on the external symptomatic behavior and consequences, not on the underlying causes and etiology.
Myth 4 – Gaming Disorder can now be treated for free by the National Health Service: Unlike many other countries, the UK has a National Health Service (NHS) whose treatment services can be accessed free of charge. A number of British newspapers reported that inclusion of GD in the ICD-11 meant that those with GD can now get free treatment. However, this claim is untenable and is unlikely to happen. All health trusts in the UK have a finite budget and allocate resources to those conditions considered a priority. Treating individuals with GD will rarely (if ever) be given priority over treatment for cancer, heart disease, schizophrenia, depression, etc. In countries where private health insurance is the norm, GD is likely to be a condition excluded for treatment on such policies even though it is now in the ICD-11.
Myth 5 – The inclusion of Gaming Disorder as a mental disorder will lead to ‘millions’ of children being stigmatized for their videogame playing: This myth has been propagated by a group of scholars (mainly researchers working in the media studies field) but is completely unsubstantiated. The number of children who would ever be officially be diagnosed as having GD is extremely low and – as noted above – millions of children play videogames for enjoyment without any problems or stigma.
(Please note: This article is based on an editorial that I first published earlier this year: Griffiths, M.D. (2018). Five myths about gaming disorder. Social Health and Behavior Journal, 1, 2-3)
Dr Mark Griffiths, Distinguished Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Aarseth, E., Bean, A. M., Boonen, H., Colder Carras, M., Coulson, M., Das, D., … & Haagsma, M. C. (2017). Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. Journal of Behavioral Addictions, 6(3), 267-270.
Gentile, D.A., Bailey, K., Bavelier, D., Funk Brockmeyer, J., … & Young, K. (2017). The state of the science about Internet Gaming Disorder as defined by DSM-5: Implications and perspectives, Pediatrics, 140, S81-S85. doi: 10.1542/peds.2016-1758H
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2017). Behavioural addiction and substance addiction should be defined by their similarities not their dissimilarities. Addiction, 112, 1718-1720.
Griffiths, M.D. (2018). Conceptual issues concerning internet addiction and internet gaming disorder. International Journal of Mental Health and Addiction, 16, 233-239.
Griffiths, M.D., Kuss, D.J., Lopez-Fernandez, O., & Pontes, H.M. (2017). Problematic gaming exists and is an example of disordered gaming. Journal of Behavioral Addictions, 6, 296-301.
European Games Developer Foundation. Statement on WHO ICD-11 list and the inclusion of gaming. 2018 June 15. Available from: http://www.egdf.eu/wp-content/uploads/2018/06/Industry-Statement-on-18-June-WHO-ICD-11.pdf
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., Griffiths, M.D., King, D., Lee, H-K., Lee, S-Y., Bányai, F., Zsila, A. Demetrovics, Z. (2018). An overview of policy responses to problematic videogame use. Journal of Behavioral Addictions, 7, 503-517.
Kuss, D.J., Griffiths, M.D. & Pontes, H.M. (2017). Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field. Journal of Behavioral Addictions, 6, 103-109.
Kuss, D.J., Pontes, H.M. & Griffiths, M.D. (2018). Neurobiological correlates in Internet Gaming Disorder: A systematic review. Frontiers in Psychiatry, 9, 166. doi: 10.3389/fpsyt.2018.00166
Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.
Rumpf, H. J., Achab, S., Billieux, J., Bowden-Jones, H., Carragher, N., Demetrovics, Z., … & Saunders, J. B. (2018). Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective: Commentary on: A weak scientific basis for gaming disorder: Let us err on the side of caution (van Rooij et al., 2018). Journal of Behavioral Addictions, 7(3), 556-561.
Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. Farriols-Hernando, N. & Torres-Jimenez, E. (2018). Internet gaming disorder treatment: A case study evaluation of four adolescent problematic gamers. International Journal of Mental Health and Addiction, https://doi.org/10.1007/s11469-017-9845-9.
In a previous 2014 blog, I looked at the psychology of shoplifting (which I called ‘Men of Steal’) based on the work of American psychologist John C. Brady (who’s upcoming book is also entitled ‘Men of Steal’). Brady is a really engaging writer and he recently published an article in Counsellor magazine on celebrity theft and why for some people it should be classed as an addiction.
Brady briefly recounted the cases of three celebrities who had been caught shoplifting (Lindsay Lohan, Kim Richards, and Winona Ryder – click on the links to get the stories of each of these celebrity shoplifting stories). Other famous celebrity shoplifters include Britney Spears, Megan Fox, Kristin Cavallari, Farrah Fawcett, and WWE Diva Emma (if you’re really interested in these and other celebrity shoplifters, then check out this story in Rebel Circus). According to Dr. Brady “psychological analysis reveals they are not greedy, rather they are addicted to the ‘rush’ associated with theft” and that there is an ‘addictive criminal syndrome’.
Brady’s article used the ‘celebrity’ angle as the ‘hook’ to write more generally about ‘shoplifting addictions’ and briefly outlined the cases of three high profile ‘theft addicts’:
“The first man is Bruce McNall, former LA Kings owner, Hollywood film producer, and a convicted felon. He received five years in Lompoc Federal Prison for stealing $238 million. The second man, John Spano, former owner of the New York Islanders, went off to two terms in federal prisons for stealing $80 million. He is currently an inmate in an Ohio prison doing ten more years for a crime he did not originate. Finally, William “Boots” Del Biaggio III, former Silicon Valley venture capitalist operator and founder of Heritage Bank in San Jose, graduated in 2016 from eight years at Lompoc for fraud. He stole $110 million to buy the Nashville Predators hockey team. He later expressed regret—maybe too little too late”.
Brady believes that these individuals had a behavioural addiction to stealing. The cases he outlined were all true and were examples of what Brady described as “elite offenders who became addicted to the rush connected to stealing”. Some commonalities between the three individuals was noted: they were charming, deceptive, had personalities that were outgoing, never used violence or aggression in the carrying out of their thefts, and (in Brady’s view) were addicted to crime. Like many addicts, they harmed themselves, their families, and their communities as a consequence of their behaviour.
The idea of being addicted to crime is not new, and the addiction components model that I have developed over the last couple of decades was based on that of one of my mentors – Iain Brown – who used such a model to explain addictive criminal offending in a really good book chapter published back in 1997 (in the book Addicted to Crime? edited by the psychologists John Hodge, Mary McMurran and Clive Hollin – see ‘Further reading’ below). Like me, Brady also read Addicted to Crime? in which it was posited that some criminals appear to become addicted to stealing (and that the act of theft made them feel good psychologically by providing a ‘high’ or a ‘rush’ similar to the feelings individuals experience when they ingest psychoactive substances). Brady argues that an addiction to stealing is a behavioural addiction and that it is “functionally equivalent” to substance-based addictions for two main reasons: that theft addicts (i) “generally derive the same initial uplifting, euphoric, and subjective sensations similar to substance abusers”, and (ii) “are almost blindly driven toward their goal and they cannot stop their self-defeating behaviors”.
Brady contends that there are five addictive criminal stages of what he terms “the zone”: (i) criminal triggers, (ii) moral neutralisation, (iii) commission of the criminal act, (iv) post-criminal-act exhilaration, and (v) post-criminal-act confusion. Brady asserts:
“The five addictive stages comprising the criminal addictive zone helps explain why certain offenders arrived at such low points in their lives and progressively became drawn deeper into the addictive zone. Because these three men became frozen into one or more of these stages, they simply could not easily find an exit sign. I have applied this criminal zonal theory to a variety of deviant groups, including white-collar deviants and now to these three elite, nonviolent bank robbers. An analysis of the criminal addictive personality forms the foundation of the addictive zone. This zone is marked with multiple, negative psychological forces evidenced during each of the five stages…The movement through these overlapping stages results in a negative, criminological, transformative process during which theft addicts surrender their prior noncriminal status (positive), thereby adopting a new deviant one (negative)…After entering into this enigmatic zone, offenders often become locked into one or more of these overlapping stages. The one factor that remains constant is that the progression through these five stages dramatically and unalterably changed these men’s lives, their victims’ lives, and the lives of people around them”.
Brady’s five addictive criminal stages are:
- Criminal triggers – In the first stage. these internal triggers revolve around salience and low self-esteem and comprise “confusing and mostly illogical thoughts” that criminals acquire. These negative thoughts are “reflective of peoples’ compromised self-concepts coupled with the desire to overcompensate for perceived personal shortcomings” and primarily originate from feelings of loneliness, emptiness, and inadequacy.
- Moral neutralisation – In the second stage, Brady claims that this stage is the most complex and essential of all the stages and is rooted in conflict. The destructive and self-defeating behaviour that criminals experience is not driven by material (economic) motives but is simply individuals “trying to enrich their empty shell identities” and fuelled by irrational thoughts of wanting to prove to significant others that they are really important. These motives may be completely unconscious
- Commission of the criminal act – In the third stage, the actual carrying out of the criminal acts demands that criminals “neutralize the unsavory aspects of their offenses…and lend meaning to inexplicable behaviors”. The more a criminal engages in the activity the more criminals become “skilled practitioners in the art of self-deception”. Here, the criminal behaviour is paired with “exciting sensations” associated with the risk of engaging in criminal activity (“an anticipated visceral feeling or mental excitement and stimulation, if not an elation, a thrill, a rush, and even a sense of euphoria”). In short, the euphoric sensations experienced reinforce the criminal behaviour.
- Post-criminal-act exhilaration – In the fourth stage, Brady claims there is typically a “flooding of mood-elevating feelings similar to an adrenaline rush, accompanied with thoughts that synthetically increase their sense of well-being” and what my mentor Iain Brown refers to as “hedonic mood management”. In short, the criminal act can help individuals feel like “bigshots” and criminals may justify doing something bad because it makes them feel so good. Brady also claims that many of these exhilarating feelings “manifest themselves on an unconscious level that is easily experienced, yet not easily comprehended by a theft addict”
- Post-criminal-act confusion – In the fifth stage, Brady claims that the mood modifying experiences in the third and fourth stages are “replaced with new, dramatic, and unexpected changes in the offenders’ emotional awareness”. Here, criminals become confused, depressed and socially withdrawn, as well as experiencing withdrawal-like reactions (e.g., sweating, headaches, anxiety, nausea, heart arrhythmia, etc.). Brady says that on a psychological level, the fifth stage five is characterized by “confusion, guilt, afterthoughts, misgivings, anxiety, depression, and dramatic mood shifts ranging from feelings of sadness to hopelessness”. It is also during this stage that criminals might start to show signs of remorse.
Brady concludes that for the criminals he has known and treated “used the stolen money to boost their status and enhance their enormous egos so they could attain ‘big shot’ fame”. I find this last observation interesting given a previous blog that I wrote on fame being addictive. I’ve also written other blogs on addictive criminal behaviour (such as joy-riding).
I am of the opinion that specific types of crime can be classed as an addictive behaviour because addictions rely on constant rewards (i.e., reinforcement) and crime can provide many rewarding experiences (both financially and psychologically), at least in the short-term. I’m not for one-minute condoning such behaviour, just simply stating my opinion that I believe it’s theoretically possible to become addicted to activities such as stealing.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Brady, J.C. (2013). Why Rich Women Shoplift – When They Have It All. San Jose, CA: Western Psych Press.
Brady, J.C. (2017) Celebrity theft: Unmasking addictive criminal intent. Counselor, July/August. Located at: http://www.counselormagazine.com/detailpageoverride.aspx?pageid=1729&id=15032386763
Brown, I. (1997). A theoretical model of the behavioral addictions: Applied to offending. In J.E. Hodge, M. McMurran, & C.R. Hollin (Eds.), Addicted to crime? (pp. 15–63). Chichester: Wiley.
Hodge, J.E., McMurran, M., & Hollin, C.R. (1997). Addicted to crime? Chichester: Wiley.
Shulman, T.D. (2011). Cluttered Lives, Empty Souls – Compulsive Stealing, Spending and Hoarding. West Conshohocken, PA: Infinity Publishing.
Soriano, M. (2015). 15 celebrities who were caught shoplifting. Rebel Circus, May 13. Located at: http://www.rebelcircus.com/blog/celebrities-caught-shoplifting/
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”.
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
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.
Last month, the World Health Organisation (WHO) announced that it was planning to include ‘Gaming Disorder’ (GD) in the latest edition of the International Classification of Diseases. This followed the American Psychiatric Association’s decision to include ‘Internet Gaming Disorder’ in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in 2013. According to the WHO, an individual with GD is a person who lets playing video games “take precedence over other life interests and daily activities,” resulting in “negative consequences” such as “significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
I have been researching videogame addiction for nearly 30 years, and during that time I have received many letters, emails, and telephone calls from parents wanting advice concerning videogames. Typical examples include ‘Is my child playing too much?’, ‘Will playing videogames spoil my pupils’ education?’, ‘Are videogames bad for children’s health? and ‘How do I know if a child is spending too long playing videogames?’ To answer these and other questions in a simple and helpful way, I have written this article as a way of disseminating this information quickly and easily.
To begin with parents should begin by finding out what videogames their children are actually playing! Parents might find that some of them contain material that they would prefer them not to be having exposure to. If they have objections to the content of the games they should facilitate discussion with children about this, and if appropriate, have a few rules. A few aims with children should be:
- To help them choose suitable games which are still fun
- To talk with them about the content of the games so that they understand the difference between make-believe and reality
- To discourage solitary game playing
- To guard against obsessive playing
- To follow recommendations on the possible risks outlined by videogame manufacturers
- To ensure that they have plenty of other activities to pursue in their free time besides the playing of videogames
Parents need to remember that in the right context videogames can be educational (helping children to think and learn more quickly), can help raise a child’s self-esteem, and can increase the speed of their reaction times. Parents can also use videogames as a starting point for other activities like painting, drawing, acting or storytelling. All of these things will help a child at school. It needs to be remembered that videogame playing is just one of many activities that a child can do alongside sporting activities, school clubs, reading and watching the television. These can all contribute to a balanced recreational diet.
The most asked question a parent wants answering is ‘How much videogame playing is too much? To help answer this question I devised the following checklist. It is designed to check if a child’s videogame playing is getting out of hand. Ask these simple questions. Does your child:
- Play videogames every day?
- Often play videogames for long periods (e.g., 3 to 6 hours at a time)?
- Play videogames for excitement or ‘buzz’ or as a way of forgetting about other things in their life?
- Get restless, irritable, and moody if they can’t play videogames?
- Sacrifice social and sporting activities to play videogames?
- Play videogames instead of doing their homework?
- Try to cut down the amount of videogame playing but can’t?
If the answer is ‘yes’ to more than four of these questions, then your child may be playing too much. But what can you do if your child is playing videogames too much?
- First of all, check the content of the games. Try and give children games that are educational rather than the violent ones. Parents usually have control over what their child watches on television – videogames should not be any different.
- Secondly, try to encourage video game playing in groups rather than as a solitary activity. This will lead to children talking and working together.
- Thirdly, set time limits on children’s playing time. Tell them that they can play for a couple of hours after they have done their homework or their chores – not before.
- Fourthly, parents should always get their children to follow the recommendations by the videogame manufacturers (e.g., sit at least two feet from the screen, play in a well-lit room, never have the screen at maximum brightness, and never play videogames when feeling tired).
I have spent many years examining both the possible dangers and the potential benefits of videogame playing. Evidence suggests that in the right context videogames can have positive health and educational benefits to a large range of different sub-groups. What is also clear from the case studies displaying the more negative consequences of playing is that they all involved children who were excessive users of videogames. From prevalence studies in this area, there is little evidence of serious acute adverse effects on health from moderate play. In fact, in some of my studies, I found that moderate videogame players were more likely to have friends, do homework, and engage in sporting activities, than those who played no videogames at all.
For excessive videogame players, adverse effects are likely to be relatively minor, and temporary, resolving spontaneously with decreased frequency of play, or to affect only a small subgroup of players. Excessive players are the most at-risk from developing health problems although more research is needed. If care is taken in the design, and if they are put into the right context, videogames have the potential to be used as training aids in classrooms and therapeutic settings, and to provide skills in psychomotor coordination, and in simulations of real life events (e.g., training recruits for the armed forces).
Every week I receive emails from parents claiming that their sons are addicted to playing online games or that their daughters are addicted to social media. When I ask them why they think this is the case, they almost all reply “because they spend most of their leisure time in front of a screen.” This is simply a case of parents pathologising their children’s behaviour because they think what they are doing is “a waste of time.” I always ask parents the same three things in relation to their child’s screen use. Does it affect their schoolwork? Does it affect their physical education? Does it affect their peer development and interaction? Usually parents say that none of these things are affected so if that is the case, there is little to worry about when it comes to screen time. Parents also have to bear in mind that this is how today’s children live their lives. Parents need to realise that excessive screen time doesn’t always have negative consequences and that the content and context of their child’s screen use is more important than the amount of screen time.
(N.B. This article is an extended version of an article that was originally published by Parent Zone)
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Griffiths, M.D. (2009). Online computer gaming: Advice for parents and teachers. Education and Health, 27, 3-6.
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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.
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A study published in the British Journal of General Practice in March 2017 reported that of 1,058 individuals surveyed in GP waiting rooms in Bristol (UK), 0.9% were problem gamblers and that a further 4.3% reported gambling problems that “were low to medium severity”. This is in line with other British studies carried out over the last decade which have reported problem gambling prevalence rates of between 0.5% and 0.9%.
I have long argued that problem gambling is a health issue and that GPs should routinely screen for gambling problems. Back in 2004, I published an article in the British Medical Journal about why problem gambling is a health issue. I argued that the social and health costs of problem gambling were (and still are) large at both individual and societal levels.
Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy. Adverse health consequences for problem gamblers and their partners include depression, insomnia, intestinal disorders, migraine, and other stress related disorders. In my BMJ article I also noted that analysis of calls to the GamCare national gambling helpline indicated that a small minority of callers reported health-related consequences as a result of their problematic gambling. These included depression, anxiety, stomach problems, and suicidal ideation. Obviously many of these medical problems arise through the stress of financial problems but that doesn’t make it any less of a health issue for those suffering from severe gambling problems.
Research published in the American Journal of Addictions has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study by Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side effect during withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.
Based on these findings, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. GPs routinely ask patients about smoking cigarettes and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health, and it is therefore very easy for those in the medical profession not to have the issue on their wellbeing radar. If the main aim of GPs is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge and should be taught in the curriculum while prospective doctors are at medical school. One of the reasons that GPs don’t routinely screen for problem gambling is because they are not taught about it during their medical training and therefore do not even think about screening for it in the first place. As I recommended in a report commissioned by the British Medical Association, the need for education and training in the diagnosis, appropriate referral and effective treatment of gambling problems must be addressed within GP training. More specifically, GPs should be aware of the types of gambling and problem gambling, demographic and cultural differences, and the problems and common co-morbidities associated with problem gambling. GPs should also understand the importance of screening patients perceived to be at increased risk of gambling addiction, and should be aware of the referral and support services available locally.
I also recommended that treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded by gambling-derived profit revenue.
Back in 2011, Dr. Jane Rigbye and myself published a study using Freedom of Information requests to ask NHS trusts if they had ever treated pathological gamblers. Only 3% of the trusts had ever treated a problem gambler and only one trust said they offered dedicated help and support. I’m sure if we repeated the study today, little will have changed.
It is evident that problem gambling is not, as yet, on the public health agenda in the UK. NHS services – including GP surgeries – need to be encouraged to see gambling problems as a primary reason for referral and a valid treatment option. Information about gambling addiction services, in particular services in the local area, should be readily available to gamblers and GP surgeries are a good outlet to advertise such services. Although some gambling services (such as GamCare, the gambling charity I co-founded) provide information to problem gamblers about local services, such information is provided to problem gamblers who have already been proactive in seeking gambling help and/or information. Given that very few GPs could probably treat a problem gambler, what they must have is the knowledge of who they can refer their patients to.
Calado, F. & Griffiths, M.D. (2016). Problem gambling worldwide: An update of empirical research (2000-2015). Journal of Behavioral Addictions, 5, 592–613.
Cowlishaw, S., Gale, L., Gregory, A., McCambridge, J., & Kessler, D. (2017). Gambling problems among patients in primary care: a cross-sectional study of general practices. British Journal of General Practice, doi: bjgp17X689905
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Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.
Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).
Griffiths, M.D. & Smeaton, M. (2002). Withdrawal in pathological gamblers: A small qualitative study. Social Psychology Review, 4, 4-13.
Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.
Rosenthal, R., & Lesieur, H. (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150–154.
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Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M.D., Constantine, R. & Pigott, S. (2007). The British Gambling Prevalence Survey. London: The Stationery Office.