Bed-ly serious: A brief look at ‘sleeping addiction’

As a life-long insomniac, I’ve always been interest in sleep at a personal level. In 1984, when I was studying for my psychology degree, the first ever research seminar I attended was one on the psychology of sleep by Dr. Jim Horne (who was, and I think still is, at Loughborough University). I found the lecture really interesting and although I never pursued a career in sleep research it was at that point that I started to take an interest more professionally. In my blog I’ve written a number of articles on various aspects of sleep including sexsomnia (engaging in sexual acts while sleeping, for instance, while sleepwalking), somnophilia (engaging in sexual acts while individuals are sleeping), Sleeping Beauty paraphilia (a sub-type of somnophilia in which individuals are sexually aroused by watching other people sleep), and lucid dreaming (where individuals are aware they are dreaming and exert some kind of control over the content of the dream),

More recently, I’ve been a co-author on a number of research papers in journals such as Sleep Medicine Reviews, Journal of Sleep Research, and Sleep and Biological Rhythms (see ‘Further reading below) but these have all involved either the effects of internet addiction on sleep or the psychometric evaluation of insomnia screening instruments rather than being about the psychology of sleep.

In a previous A-Z article on “strange and bizarre addictions” I included ‘sleep addiction’ as one of the entries. Obviously I don’t believe that sleeping can be an addiction (at least not by my own criteria) but the term ‘sleep addiction’ is sometimes used to describe the behaviour of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled ‘Those esoteric, exoteric and fantabulous diagnoses’ and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

In an online article entitled ‘Sleep addiction’, Amber Merton also mentioned clinomania in relation to an addiction to sleep:

“If you are obsessed with sleeping or have an intense desire to stay in bed, you could be suffering from a condition called clinomania. That doesn’t mean that there aren’t people who can experience symptoms similar to addiction and even withdrawal in association with sleep, or lack thereof”.

The reference to ‘addiction-like’ symptoms appears to have some validity based on these self-report accounts I found online. All of these individuals mention various similarities between their constant need for sleep and addiction. I have highlighted these to emphasize my assertions that some of the consequences are at the very least addiction-like:

• Extract 1: “I believe someone can become psychologically dependent on sleep. I am 47 and have used sleep for 40 years to escape from life…I typically sleep 4-6 hours too much each day. Sleep feels like an addiction to me because I crave it several times a day and am looking forward to how I can sneak it in. I don’t seem to be able to control it with will power for very long…I only have short periods when this isn’t a problem. When I am under stress it is at its worse. If I have any free or unstructured time, I can’t control how much I sleep excessively. When my time is heavily scheduled, I really struggle with keeping a full schedule and crave the time off when I can sleep for hours. If I know I’ll have a few hours in between activities free, I will find ways to sneak in some sleep. I am embarrassed about this, don’t tell the people around me the extent of the problems and devise ways to sneak in sleep without people knowing”.
• Extract 2: “I love sleeping. It feels so good I think I could even become addicted if I didn’t HAVE to wake up. I sleep about 12 hours every day and could sleep more if I didn’t have to do daily necessities. I am aware of the fact that people who generally sleep more than they are supposed to, die sooner and have other various health problems. To be honest I would rather sleep than do most things. I even choose sleep over sex a lot”.
• Extract 3: “I often sleep for 12-20 hours at a time. I have depression and am on anti-depressants. I just love sleeping. It’s so safe and comfy. I don’t know how else to explain it. It’s just amazing”.
• Extract 4: “I sleep AT LEAST 12 hours a day. But on days off I’ve been known to sleep for about 15-20 hours. [I am] addicted to sleep. I’ve cancelled social outings with friends pretending to be sick when really I just wanted to sleep in. I love sleep and I can’t get enough of it. I’ve slept through the entire weekend multiple times before, only waking up Monday morning when my alarm rang. And even after that much wonderful sleep I was still tired. The second I come home from work every day I eat, shower, and then crawl into bed and sleep the entire evening and night away. My alarm’s the only thing that can wake me up anymore…As for why I love sleep so much, I see a lot of people saying it’s an escape for them. For me it’s more, I don’t like people or going out or socializing, so sleep is my drug of choice. Is it bad? Maybe. Do I care? Not really…I more than love it, and it’s not hurting anyone if we’re being honest”.
• Extract 5: “I feel like I’m addicted to sleep. Here’s why I think though. I suffered for 13 years with depression and while I know I am still getting over it I don’t feel that’s the reason I’m addicted. During those 13 years I would have serious bouts of chronic insomnia. The doctors tried to many different sleeping medications, meditation, clinics to help me find a routine for natural sleep without meds. Nothing worked. Now I live in Thailand and my doctor here recommended melatonin tablets, all natural as your brain is supposed to produce it anyway to tell you when it’s dark it’s time to sleep and when it’s like light it’s time to wake up. She thinks my brain fails to produce certain chemicals as such with serotonin and now figured melatonin. Since I have been taking a melatonin supplement, I sleep so well, I fall asleep within 20 minutes and I sleep for AT LEAST 8 hours. When I wake up I just want to go back to sleep again because it feels amazing. I don’t feel like it’s part of my anxiety or my depression, I just think it’s because I had insomnia for so long its addictive!”
• Extract 6: “To be honest if I could I would sleep my life away. My so called normal sleeping pattern: I am awake all night. Fall asleep around 4am-8am. Sleep 12 hours. Repeat. My mind is a broken record, constantly repeating the trauma. I do suffer from depression and anxiety. Sleep is my addiction. When I sleep I feel SAFE regardless?”
• Extract 7: “I’ve been addicted to sleep (the escape from an abusive childhood, depression, and PTSD) since I was ten years old! I want to change though because my body is a mess. I’ve slept for 4 days and sometimes more with short awake periods to eat a little and use the potty. Not enough though, because now my body doesn’t work properly…Oversleeping has its consequences”.
• Extract 8: “I’m so pleased that I have found this site and other people who are addicted to sleep as this problem has plagued my adult life and I would like it to stop. Take today for instance, I woke at 5.30am and was quite awake feeling a little anxious but I could not wait to get to sleep again, so I did and stayed in bed till around 2.20 pm. I have many days like this and as the lady above the sleep state is quite lucid and I do seem to enjoy it rather than getting up and living life for real”.

Again, I reiterate that none of these individuals are addicted to sleep but in addition to the addiction-like descriptions, there is also crossover in the motivations for excessive sleep and motivations underlying addictions (most noticeably the association with depression, anxiety, psychological trauma, and using the activity as an escape). In relation to addiction, these extracts include references to salience (engaging in sleep to the neglect of everything else in their life), cravings (for sleep), the sleep being excessive, repetitive and habitual, sleep leading to negative consequences (conflict), and loss of control. The fact that many of these individuals describe their behaviour as an addiction or addictive doesn’t mean that it is.

While there is no academic paper that I know of that has ever claimed sleep can be a genuine addiction there are countless clinical and empirical papers examining excessive sleep (i.e., hypersomnia) and the different etiological pathways that can lead to hypersomnia. Although hypersomnia is not an addiction, those with the condition (like addicts) can suffer many negative side-effects from the relatively minor (e.g., low energy, fatigue, headaches, loss of appetite, restlessness, hallucinations) to the more severe (e.g., diabetes, obesity, heart disease, clinical depression, memory loss, suicidal ideation, and in extreme cases, death). In one online article I came across, the similarity between hypersomnia and addiction in relation to depression was evident:

“It’s important to note that in some cases separating cause from effect here can be muddled. For instance, does over sleeping contribute to depression or does depression contribute to oversleeping? Or are both oversleeping and depression the effect of a larger underlying cause? Furthermore, once a person is experiencing both, could they act to reinforce the other as a feedback loop?”

This observation could just as easily be made about most addictions (substance or behavioural). Finally, it’s worth noting that there are many sub-types of hypersomnia and excessive sleep. In a good review of hypersomnia [HS] in Current Neurology and Neuroscience Reports, Dr. Yves Dauvilliers notes the following hypersomnia sub-types (including narcolepsy which can include excessive sleep but isn’t usually classed as a type of hypersomnia; also note that ‘idiopathic’ means of unknown cause) which I have paraphrased below:

• Narcolepsy: This is a disabling neurologic disorder characterized by excessive daytime sleep (EDS) and cataplexy (i.e., a sudden loss of voluntary muscular tone without any alteration of consciousness in relation with strong emotive reactions such as laughter, joking).
• Narcolepsy without cataplexy: This is simply a variant of narcolepsy with cataplexy (but without the cataplexy).
• Idiopathic hypersomnia: Idiopathic HS is rare and remains a relatively poorly defined condition due to the absence of specific symptoms such as cataplexy or sleep apneas (i.e., loss of breathing while sleeping).
• Recurrent hypersomnia: This HS is characterized by repeated episodes of excessive sleep (at least 16 hours a day) lasting from a few days up to several weeks. The most well-known recurrent HS is Kleine-Levin syndrome which comprises both cognitive disturbances (feelings of confusion and unreality) and behavioural disturbances (such as overeating and hypersexual behaviour during symptomatic episodes).
• Hypersomnia associated with neurologic disorders: This type of HS causes EDS and can be a result of brain tumours, dysfunction in the thalamus, hypothalamus, or brainstem that may mimic idiopathic HS or narcolepsy.
• Hypersomnia associated with infectious disorders: This type of HS can be a result of viral infection such as HIV pneumonia, Whipple’s disease (a systemic disease most likely caused by a gram-positive bacterium), or Guillain-Barré syndrome (a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system).
• Hypersomnia associated with metabolic or endocrine disorders: This type of HS can be a result of conditions such as hyperthyroidism, diabetes, hepatic encephalopathy (a liver dysfunction among individuals with cirrhosis), and acromegaly (a hormonal disorder that develops when the pituitary gland produces too much growth hormone).
• Hypersomnia caused by drugs: This type of HS is secondary to many different types of drug medication including hypnotics, anxiolytics, antidepressants, neuroleptics, anti-histamines, and anti-epileptics.
• Hypersomnia not caused by drugs or known physiologic conditions: This type of HS can be caused by a range of disorders such as depressive disorder, seasonal affective disorder, and abnormal personality traits.

None of these types of HS is an addiction but clearly the negative consequences can be just as serious for the individual.

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

Further reading

Alimoradi, Z., Lin, C-Y., Broström, A., Bülow, P.H., Bajalan, Z., Griffiths, M.D., Ohayon, M.M. & Pakpour, A.H. (2019). Internet addiction and sleep problems: A systematic review and meta-analysis. Sleep Medicine Review, 47, 51-61.

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

Bener, A., Yildirim, E., Torun, P., Çatan, F., Bolat, E., Alıç, S., Akyel, S., & Griffiths, M.D. (2019). Internet addiction, fatigue, and sleep problems among students: A largescale survey study. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-018-9937-1

Billiard, M., & Dauvilliers, Y. (2001). Idiopathic hypersomnia. Sleep Medicine Reviews, 5(5), 349-358.

Dauvilliers, Y. (2006). Differential diagnosis in hypersomnia. Current Neurology and Neuroscience Reports, 6(2), 156-162.

Domenighini, A. (2016). Can you be addicted to sleep? Vice, January 24. Located at: https://www.vice.com/en_us/article/mg7e33/can-you-be-addicted-to-sleep

Hawi, N.S., Samaha, M., & Griffiths, M.D. (2018). Internet gaming disorder in Lebanon: Relationships with age, sleep habits, and academic achievement. Journal of Behavioral Addiction, 7, 70-78.

Mamun, M.A. & Griffiths, M.D. (2019). Internet addiction and sleep quality: A response to Jahan et al. (2019). Sleep and Biological Rhythms. doi: 10.1007/s41105-019-00233-0

Merton, A. (2008). Sleep addiction. Located at: https://www.plushbeds.com/blog/sleep-disorders/sleep-addiction/

Mignot, E. J. (2012). A practical guide to the therapy of narcolepsy and hypersomnia syndromes. Neurotherapeutics, 9(4), 739-752.

Pakpour, A., Lin, C-Y., Cheng, A.S., Imani, V., Ulander, M., Browall, M. Griffiths, M.D., Broström, A. (2019). A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer. Journal of Sleep Research. doi: 10.1111/jsr.12891.

World of the Weird: The A-Z of strange and bizarre addictions

Today’s blog takes a brief look at some of the stranger addictions that have been written about in the academic literature (or academics that have tried to argue these behaviours can be addictive). Some of these ‘addictions’ listed are not addictions by my own criteria but others have argued they are. The papers or books that have argued the case for the cited behaviour being a type of addiction are found in the ‘Further reading’ section.

• Argentine tango addiction: A French study published in a 2013 issue of the Journal of Behavioral Addictions by Remi Targhetta and colleagues argued that a minority of 1129 Argentine tango dancers they surveyed may be addicted to dancing. In 2015, I and some of my Hungarian colleagues developed the Dance Addiction Inventory (published in PLoS ONE) and also argued that a minority of dancers (more generally) might be addicted to dance and conceptualized the behaviour as a form of exercise addiction.
• Badminton addiction: While there are many behaviours I could have chosen here including addictions to box set television watching (aka ‘box set bingeing), bargain hunting, bungee jumping, blogging, and bodybuilding, a recent 2018 paper published in NeuroQuantology by Minji Kwon and colleagues carried out a neuroimaging study on a sample 45 badminton players. Using the Korean Exercise Addiction Scale, 20% of the sample were defined as being addicted to badminton.
• Carrot eating addiction: Again, there are many behaviours I could have chosen here including alleged addictions to crypto-trading, chaos, collecting, crosswords, and cycling, there are a number of published case studies in the psychological literature highlighting individuals addicted to eating carrots including papers by Ludek Černý and Karel Černý, K. (British Journal of Addiction, 1992), and Robert Kaplan (Australian and New Zealand Journal of Psychiatry, 1996).
• Death addiction: A recent paper by Dr. Marc Reisinger entitled ‘Addiction to death’ in the journal CNS Spectrums attempted to argue that attraction to death be considered an addiction similar to gambling addiction. Reisinger related the concept to individuals who have left Europe to join the jihad in Syria, and outlined the case of 24-year-old French-Algerian Mohamed Merah who committed several attacks in Toulouse in 2012 and who ‘glorified’ death. Te paper claimed that this “addiction to death is taught by Salafist preachers, whose videos, readily accessible on the internet, are kind of advertisements for death, complete with depictions of soothing fountains and beautiful young girls”.
• Entrepreneurship addiction: There are a couple of papers by April Spivack and Alexander McKelvie (a 2014 paper in the Journal of Business Venturing, and a 2018 paper Academy of Management) arguing that entrepreneurship can be addictive. They define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. They also make the case that that entrepreneurship addiction is different from workaholism.
• Fortune telling addiction: Although I could have included addictions to financial trading or fame, a 2015 paper in the Journal of Behavioral Addictions by Marie Grall-Bronnec and her colleagues reported the case study of a woman (Helen) that was ‘addicted’ to fortune tellers. They used my addiction criteria to assess whether Helen was addicted to fortune telling, and argued that she was.
• Google Glass addiction: In previous blogs I have written on addictions to gossip and gardening (although these were based more on non-academic literature). However, a 2015 paper published by Kathryn Yung and her colleagues in the journal Addictive Behaviors, published the first (and to my knowledge) only case of addiction to Google Glass (wearable computer-aided glasses with Bluetooth connectivity to internet-ready devices. The authors claimed that their paper, (i) showed that excessive and problematic uses of Google Glasscan be associated with involuntary movements to the temple area and short-term memory problems, and (ii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass.
• Hacking addiction: Back in the late 1990s and early 2000s I wrote a number of papers on internet addiction and included ‘hacking addiction’ as a type of internet addiction. Given the criminal element of this type of internet addiction I wrote about it in criminological-based journals such as The Probation Journal (1997) and The Police Journal (2000). One of the most infamous cases that I have written about took place in London in 1993, where Paul Bedworth was accused of hacking-related crime causing over £500,000 worth of damage. On the basis of expert witness testimony, he was acquitted on the basis that he was addicted to hacking. Since then, various papers have been published arguing that hacking can be an addiction. For instance, in an in-depth interview study of 62 hackers, Siew Chan and Lee Yao used addiction as a framework to explain their participants’ behaviour (see their paper in the Review of Business Information Systems, 2005).
• Internet search addiction: Although I was tempted to go for IVF addiction, I thought I would go for ‘internet search addiction’ which basically refers to constant ‘googling’ where individuals spend hours and hours every day using online databases to go searching for things. This behaviour was first alluded to by Kimberley Young in her 1999 classification of different types of internet addiction which she called ‘information overload’ and was defined as compulsive web surfing or database searches. More recently, Yifan Wang and her colleagues developed the Questionnaire on Internet Search Dependence (QISD) published in Frontiers in Public Health (FiPH). I criticized the QISD in a response paper published in FiPH, not because I didn’t think internet search addiction didn’t exist (because theoretically it might do, even though I’ve never come across a genuine case) but because the items in the instrument had very little to do with addiction.
• Joyriding addiction: There have been a number of academic papers published on joyriding addiction. Arguably the most well-known study was published by Sue Kellett and Harriet Gross in a 2006 issue of Psychology, Crime and Law. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”). The results of the study indicated that all addiction criteria occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. The paper also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended.
• Killing addiction: The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman. In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I examined in a previous blog). One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog).
• Love addiction: In the psychological literature, the concept of love addiction has been around for some time dating back to works by Sigmund Freud. Arguably the most cited work in this area is the 1975 book Love and Addiction by Stanton Peele and Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. There have also been a number of instruments developed assessing love addiction including the Love Addiction Scale (developed by Hunter, Nitschke, and Hogan, 1981), and the Passionate Love Scale (developed by Hatfield, and Sprecher, 1986).
• Muscle dysmporphia as an addiction: In a paper I published with Andrew Foster and Gillian Shorter in a 2015 issue of the Journal of Behavioral Addictions, we argued that muscle dysmorphia (MD) could be classed as an addiction. MD is a condition characterised by a misconstrued body image in individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a body dysmorphic disorder, an eating disorder, and/or part of the obsessive-compulsive disorder symptomatology. Reviewing the most salient literature on MD, we proposed an alternative classification of MD that we termed the ‘Addiction to Body Image’ (ABI) model. We argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating specific foods, taking specific drugs (e.g., anabolic steroids), shopping for specific foods, food supplements, and/or physical exercise accessories, etc.. In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Based on empirical evidence, we proposed that MD could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.
• News addiction: Although I could have chosen nasal spray addiction or near death addiction, a recent 2017 paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Ghulam Ishaq and colleagues. The authors used some of my papers on behavioural addiction to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. The authors also developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. In relation to personality types (and like other addictions), they found news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.
• Online auction addiction: A number of academics have made the claim that some individuals can become addicted to participating in online auctions. In a 2004 paper on internet addiction published in American Behavioral Scientist, Kimberley Young mentioned online auction [eBay] addiction in passing. The same observation was also made in a later 2009 paper by Tonino Cantelmi and Massimo Talls in the Journal of CyberTherapy and Rehabilitation. Other researchers have carried out empirical studies including a (i) 2007 paper by Cara Peters and Charles Bodkin in the Journal of Retailing and Consumer Services, (ii) 2008 paper by Chih-Chien Wang in the Proceedings of the Asia-Pacific Services Computing Conference, and (iii) 2011 study carried out by Dr. Ofir Turel and colleagues published in the MIS Quarerly. These papers indicated that those with problematic online auction use experienced (i) psychological distress, (ii) habitual usage, (iii) compulsive behaviour, (iv) negative consequences, and/or (v) dependence, withdrawal and self-regulation.
• Pinball addiction: Although I could have listed alleged addictions to plastic surgery and poetry, as far as I am aware, I am the only academic to have published a paper on pinball addiction. Back in 1992, I published a case study in Psychological Reports. My paper featured the case of a young man (aged 25 years) who (based on classic addiction criteria) was totally hooked on pinball. It was the most important thing in his life, used the behaviour to modify his moods, got withdrawal symptoms if he was unable to play pinball, had engaged in repeated efforts to cut down or stop playing pinball, and compromised all other activities in his life (education, occupation and relationships). To me, this individual had a gaming addiction but it was pinball rather than videogame addiction.
• Qat addiction: Qat (sometimes known as khat, kat, cat, and ghat) is a flowering plant traditionally used as a mild stimulant in African and Middle East countries (Somalia, Yemen, Ethiopia). Heavy qat users can experience many side effects including insomnia, anxiety, increased aggression, high blood pressure, and heart problems. There are numerous reports in the medical literature of qat addiction (see papers by Rita Manghi and colleagues in the Journal of Psychoactive Drugs, and Nezar Al-Hebshi and Nils Skuag in Addiction Biology).
• Rock climbing addiction: Over the past two years, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving. In the first paper on withdrawal symptoms published in 2016 in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports (in this case rock climbing). The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioural addictions. In a second investigation just published in Frontiers in Psychology, the same team reported the development of the Rock Climbing Craving Questionnaire comprising three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’).
• Study addiction: I was spoilt for choice on the letter ‘S’ and could have mentioned addictions to speeding, selfie-taking, shoplifting, Sudoko, and stock market speculation. However, there are now a number of published papers on ‘study addiction’ (individuals addicted to their academic study), three of which I have co-authored (all in the Journal of Behavioral Addictions and led by my colleague Pawel Atroszko). We have conceptualised study addiction as a type of work addiction (or a pre-cursor to work addiction) and in a series of studies (including longitudinal research) we have found empirical evidence of ‘study addiction’. Italian researchers (Yura Loscalzo and Marco Giannini) have also published research on ‘overstudying’ and ‘studyholism’ too (in the journals ARC Journal of Psychiatry, 2017; Social Indicators Research, 2018).
• Tanning addiction: There is now lots of empirical research examining ‘tanorexia’ (individuals who crave tanning and spend every day on sunbeds). However, I along with my colleagues in Norway recently reconceptualised tanorexia as a ‘tanning addiction’ and developed a scale to assess it (which was recently published in a 2018 issue of the British Journal of Dermatology). Our study was the largest over study on tanning (over 23,000 participants) and our newly developed scale (the Bergen Tanning Addiction Scale) had good psychometric properties.
• Upskirting addiction: Upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. In the UK there have been a number of high profile court cases including Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos), and Andrew MacRae who had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. Both men avoided a custodial sentence because their lawyers argued they were addicted and/or had a compulsion to upskirting. In a 2017 issue of the Law Gazette, forensic psychologist Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. Dr. Lam also talked about her treatment of upskirting voyeurs and recounted one case which she claimed was a compulsion (and who was successfully treated). The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress.
• Virtual reality addiction: Back in 1995, in a paper I entitled ‘Technological addictions’ in the journal Clinical Psychology Forum, I asserted that addiction to virtual reality would be something that psychologists would be seeing more of in the future. Although I wrote the paper over 20 years ago, there is still little empirical evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself). Of all the behaviours on this list, this is the one where there is less good evidence for its existence. Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.
• Water addiction: In a blog I wrote back in 2015, I recounted some press stories on individuals who claimed they were ‘addicted’ to drinking water. My research into the topic led to a case study of ‘water dependence’ published a 1973 issue of the British Journal of Addiction by E.L. Edelstein. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. This led me to a condition called polydipsia (which in practical terms means drinking more than three litres of water a day) which often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. There are also dozens and dozens of academic papers on psychogenic polydipsia (PPD). A paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. A 2000 study in European Psychiatry by E. Mercier-Guidez and G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. Whether ‘water intoxication’ is a symptom of being ‘addicted’ to water depends upon the definition of addiction being used.
• X-ray addiction: OK, this one’s a little bit of a cheat but what I really wanted to concentrate on what has been unofficially termed factitious disorder (FD). According to Kamil Jaghab and colleagues in a 2006 issue of the Psychiatry journal “FD is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction”. The primary characteristic of people suffering from FD is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). It is called a factitious because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Again, whether such behaviours can be viewed as an addiction depends upon the definition of addiction being used.
• YouTube addiction: I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). The story profiled a student whose obsessive viewing of YouTube content led to extreme behaviour changes and eventually, depression and a suicide attempt. Not long after this, I and my colleague Janarthanan Balakrishnan published what we believe is the only ever study on YouTube addiction in the Journal of Behavioral Addictions. In a study of over 400 YouTube users we found that YouTube addiction was more associated with content creation than watching content
• ‘Zedding’ addiction: OK, I’m using the Urban Dictionary’s synonym here as a way of including ‘sleep addiction’. The term ‘sleep addiction’ is sometimes used to describe the behavior of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled “Those esoteric, exoteric and fantabulous diagnoses” and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

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

Further reading

Al‐Hebshi, N., & Skaug, N. (2005). Khat (Catha edulis) – An updated review. Addiction Biology, 10(4), 299-307.

Andreassen, C.S., Pallesen, S. Torsheim, T., Demetrovics, Z. & Griffiths, M.D. (2018). Tanning addiction: Conceptualization, assessment, and correlates. British Journal of Dermatology. doi: 10.1111/bjd.16480

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

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.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D., Pallesen, S. (2016). The relationship between study addiction and work addiction: A cross-cultural longitudinal study. Journal of Behavioral Addiction, 5, 708–714.

Balakrishnan, J. & Griffiths, M.D. (2017). Social media addiction: What is the role of content in YouTube? Journal of Behavioral Addictions, 6, 364-377.

Black, D., Belsare, G., & Schlosser, S. (1999). Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. Journal of Clinical Psychiatry, 60, 839-843.

Burn, C. (2016). Poesegraphilia – Addiction to the act of writing poetry. Poetry Changes Lives, May 27. Located at: http://www.poetrychangeslives.com/addiction-to-the-act-of-writing-poetry/

Cantelmi, T & Talls, M. (2009). Trapped in the web: The psychopathology of cyberspace. Journal of CyberTherapy and Rehabilitation, 2, 337-350.

Černý, L. & Černý, K. (1992). Can carrots be addictive? An extraordinary form of drug dependence. British Journal of Addiction, 87, 1195-1197.

Chan, S. H., & Yao, L. J. (2005). An empirical investigation of hacking behavior. The Review of Business Information Systems, 9(4), 42-58.

Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html

de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.

Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.

Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.

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.

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

Grall-Bronnec, M. Bulteau, S., Victorri-Vigneau, C., Bouju, G. & Sauvaget, A. (2015). Fortune telling addiction: Unfortunately a serious topic about a case report. Journal of Behavioral Addiction, 4, 27-31.

Griffiths, M.D. (1992). Pinball wizard: A case study of a pinball addict. Psychological Reports, 71, 160-162.

Griffiths, M.D. (2000). Computer crime and hacking: A serious issue for the police. Police Journal, 73, 18-24.

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 5, 95. doi: 10.3389/fpubh.2017.00095

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

Hatfield, E., & Sprecher, S. (1998). The passionate love scale. In Fisher, T.D., Davis, C.M., Yarber, W.L. & Davis, S. (Eds.). Handbook of sexuality-related measures (pp. 449-451). London: Sage.

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.

Hickey, E.W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Hunter, M. S., Nitschke, C., & Hogan, L. 1981. A scale to measure love addiction. Psychological Reports, 48, 582-582.

Ishaq, G., Rafique, R., & Asif, M. (2017). Personality traits and news addiction: Mediating role of self-control. Journal of Dow University of Health Sciences, 11(2), 31-53.

Jaghab, K., Skodnek, K. B., & Padder, T. A. (2006). Munchausen’s syndrome and other factitious disorders in children: Case series and literature review. Psychiatry (Edgmont), 3(3), 46-55.

Kaplan, R. (1996), Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30, 698-700.

Kellett, S.  & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders’ accounts of their car crime. Psychology, Crime & Law, 12, 39-59.

Kennedy, J. G., Teague, J., & Fairbanks, L. (1980). Qat use in North Yemen and the problem of addiction: a study in medical anthropology. Culture, medicine and psychiatry, 4(4), 311-344.

Kwon, M., Kim, Y., Kim, H., & Kim, J. (2018). Does sport addiction enhance frontal executive function? The case of badminton. NeuroQuantology, 16(6), 13-21.

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Loscalzo, Y, & Giannini, M. (2017).  Evaluating the overstudy climate at school and in the family: The Overstudy Climate Scale (OCS). ARC Journal of Psychiatry, 2(3), 5-10.

Loscalzo, Y., & Giannini, M. (2018). Study engagement in Italian university students: A Confirmatory Factor Analysis of the Utrecht Work Engagement Scale—Student Version. Social Indicators Research, Epub ahead of print. https://doi.org/10.1007/s11205-018-1943-y

Manghi, R. A., Broers, B., Khan, R., Benguettat, D., Khazaal, Y., & Zullino, D. F. (2009). Khat use: lifestyle or addiction? Journal of Psychoactive Drugs, 41(1), 1-10.

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.

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

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

Menninger, K. A. (1934). Polysurgery and polysurgical addiction. The Psychoanalytic Quarterly, 3(2), 173-199.

Mercier-Guidez, E., & Loas, G. (2000). Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. European Psychiatry, 15(5), 306-311.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Peters, C.  & Bodkin, C.D. (2007). An exploratory investigation of problematic online auction behaviors: Experiences of eBay users. Journal of Retailing and Consumer Services, 14(1), 1-16.

Reisinger, M. (2018). Addiction to death. CNS Spectrums, 23(2), 166-169.

Relangi, K. (2012). Gossip, the ugly addiction. Purple Room Healing, June 12. Located at: https://deadmanswill.wordpress.com/2012/06/02/gossip-the-ugly-addiction/

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

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Sparrow, P. & Griffiths, M.D. (1997). Crime and IT: Hacking and pornography on the internet. Probation Journal, 44, 144-147.

Spivack, A., & McKelvie, A. (2018). 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.

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

Turel, O., Serenko, A. & Giles, P. (2011). Integrating technology addiction and use: An empirical investigation of online auction users. MIS Quarterly, 35, 1043-1061.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2017). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Wang, C-C. (2008). The influence of passion and compulsive buying on online auction addiction. Proceedings of the Asia-Pacific Services Computing Conference (pp. 1187 – 1192). IEEE.

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

Wright, M. R. (1986). Surgical addiction: A complication of modern surgery? Archives of Otolaryngology–Head & Neck Surgery, 112(8), 870-872.

Wulfsohn, I. (2013). A dangerous addiction: Qat and its draining of Yemen’s water, economy, and people. Middle East Economy, 3(10), 1-5.

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

Young, K. S. (2004). Internet addiction: A new clinical phenomenon and its consequences. American Behavioral Scientist, 48, 402–415.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, 41, 58-60.

Myth world: A brief look at some myths about Gaming Disorder

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

Further reading

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.

Trait expectations: Another look at why addictive personality is a complete myth

In the 30 years that I have been carrying out research into addiction, the one question that I have been asked the most – particularly by those who work in the print and broadcast media – is whether there is such a thing as an ‘addictive personality’? In a previous blog I briefly reviewed the concept of ‘addictive personality’ but since publishing that article, I have published a short paper in the Global Journal of Addiction and Rehabilitation Medicine on addictive personality, and in this blog I review I outline some of the arguments as to why I think addictive personality is a complete myth.

Psychologists such as Dr. Thomas Sadava have gone as far to say that ‘addictive personality’ is theoretically necessary, logically defensible, and empirically supportable. Sadava argued that if ‘addictive personality’ did not exist then every individual would vulnerable to addiction if they lived in comparable environments, and that those who were addicted would differ only from others in the specifics of their addiction (e.g., alcohol, nicotine, cocaine, heroin). However, Sadava neglected genetic/biological predispositions and the structural characteristics of the substance or behaviour itself.

There are many possible reasons why people believe in the concept of ‘addictive personality’ including the facts that: (i) vulnerability is not perfectly correlated to one’s environment, (ii) some addicts are addicted to more than one substance/activity (cross addiction) and engage themselves in more than one addictive behaviour, and (iii) on giving up addiction some addicts become addicted to another (what I and others have referred to as ‘reciprocity’). In all the papers I have ever read concerning ‘addictive personality’, I have never read a good operational definition of what ‘addictive personality’ actually is (beyond the implicit assumption that it refers to a personality trait that helps explain why individuals become addicted to substances and/or behaviours). Dr. Craig Nakken in his book The Addictive Personality: Understanding the Addictive Process and Compulsive Behaviour argued that ‘addictive personality’ is “created from the illness of addiction”, and that ‘addictive personality’ is a consequence of addiction and not a predisposing factor. In essence, Nakken simply argued that ‘addictive personality’ refers to the personality of an individual once they are addicted, and as such, this has little utility in understanding how and why individuals become addicted.

When teaching my own students about the concept of ‘addictive personality’ I always tell them that operational definitions of constructs in the addictive behaviours field are critical. Given that I have never seen an explicit definition of ‘addictive personality’ I provide my own definition and argue that ‘addictive personality’ (if it exists) is a cognitive and behavioural style which is both specific and personal that renders an individual vulnerable to acquiring and maintaining one or more addictive behaviours at any one time. I also agree with addiction experts that the relationship between addictive characteristics and personality variables depend on the theoretical considerations of personality. According to Dr. Peter Nathan there must be ‘standards of proof’ to show valid associations between personality and addictive behaviour. He reported that for the personality trait or factor to genuinely exist it must: (i) either precede the initial signs of the disorder or must be a direct and lasting feature of the disorder, (ii) be specific to the disorder rather than antecedent, coincident or consequent to other disorders/behaviours that often accompany addictive behaviour, (iii) be discriminative, and (iv) be related to the addictive behaviour on the basis of independently confirmed empirical, rather than clinical, evidence. As far as I am aware, there is no study that has ever met these four standards of proof, and consequently I would argue on the basis of these that there is no ‘addictive personality’.

Although I do not believe in the concept of ‘addictive personality’ this does not mean that personality factors are not important in the acquisition, development, and maintenance of addictive behaviours. They clearly are. For instance, a paper in the Psychological Bulletin by Dr. Roman Kotov and his colleagues examined the associations between substance use disorders (SUDs) and higher order personality traits (i.e., the ‘big five’ of openness to experience, conscientiousness, agreeableness, extraversion, and neuroticism) in 66 meta-analyses. Their review included 175 studies (with sample sizes ranged from 1,076 to 75,229) and findings demonstrated that SUD addicts were high on neuroticism (and was the strongest personality trait associated with SUD addiction) and low on conscientiousness. Many of the studies the reviewed also reported that agreeableness and openness were largely unrelated to SUDs.

Dr. John Malouff and colleagues carried published a meta-analysis in the Journal of Drug Education examining the relationship between the five-factor model of personality and alcohol. The meta-analysis included 20 studies (n=7,886) and showed alcohol involvement was associated with low conscientiousness, low agreeableness, and high neuroticism. Mixed-sex samples tended to have lower effect sizes than single-sex samples, suggesting that mixing sexes in data analysis may obscure the effects of personality. Dr. James Hittner and Dr. Rhonda Swickert published a meta-analysis in the journal Addictive Behaviors examining the association between sensation seeking and alcohol use. An analysis of 61 studies revealed a small to moderate size heterogeneous effect between alcohol use and total scores on the sensation seeking scale. Further analysis of the sensation seeking components indicated that disinhibition was most strongly correlated with alcohol use.

Dr. Marcus Munafo and colleagues published a meta-analysis in the journal Nicotine and Tobacco Research examining strength and direction of the association between smoking status and personality. They included 25 cross-sectional studies that reported personality data for adult smokers and non-smokers and reported a significant difference between smokers and non-smokers on both extraversion and neuroticism traits. In relation to gambling disorder, Dr. Vance MacLaren and colleagues published a meta-analysis of 44 studies that had examined the personality traits of pathological gamblers (N=2,134) and non-pathological gambling control groups (N=5,321) in the journal Clinical Psychology Review. Gambling addiction was shown to be associated with urgency, premeditation, perseverance, and sensation seeking aspects of impulsivity. They concluded that individual personality characteristics may be important in the aetiology of pathological gambling and that the findings were similar to the meta-analysis of substance use disorders by Kotov and colleagues.

More recently, I co-authored a study with Dr. Cecilie Andreassen and her colleagues in the Journal of Behavioral Addictions. We carried out the first ever study investigating the inter-relationships between the ‘big five’ personality traits and behavioural addictions. They assessed seven behavioural addictions (i.e., Facebook addiction, video game addiction, Internet addiction, exercise addiction, mobile phone addiction, compulsive buying, and study addiction). Of 21 inter-correlations between the seven behavioural addictions, all were positive (and nine significantly so). More specifically: (i) neuroticism was positively associated with Internet addiction, exercise addiction, compulsive buying, and study addiction, (ii) extroversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying, (iii) openness was negatively associated with Facebook addiction and mobile phone addiction, (iv) agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying, and (v) conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying and positively associated with exercise addiction and study addiction. However, replication and extension of these findings is needed before any definitive conclusions can be made.

Overall these studies examining personality and addiction consistently demonstrate that addictive behaviours are correlated with high levels of neuroticism and low levels of conscientiousness. However, there is no evidence of a single trait (or set of traits) that is predictive of addiction, and addiction alone. Others have also reached the same conclusion based on the available evidence. For instance, R.G. Pols (in Australian Drug/Alcohol Review) noted that findings from prospective studies are inconsistent with retrospective and cross-sectional studies leading to the conclusion that the ‘addictive personality’ is a myth. Dr. John Kerr in the journal Human Psychopharmacology: Clinical and Experimental noted that ‘addictive personality’ had long been argued as a viable construct (particularly in the USA) but that there is simply no evidence for the existence of a personality type that is prone to addiction. In another review of drug addictions, Kevin Conway and colleagues asserted (in the journal Drug and Alcohol Dependence) there was scant evidence that personality traits were associated with psychoactive substance choice. Most recently, Maia Szalavitz in her book Unbroken Brain: A Revolutionary New Way of Understanding Addiction noted that:

“Fundamentally, the idea of a general addictive personality is a myth. Research finds no universal character traits that are common to all addicted people. Only half have more than one addiction (not including cigarettes)—and many can control their engagement with some addictive substances or activities, but not others”.

Clearly there are common findings across a number of differing addictions (such as similarities in personality profiles using the ‘big five’ traits) but it is hard to establish whether these traits are antecedent to the addiction or caused by it. Within most addictions there appear to be more than one sub-type of addict suggesting different pathways of how and way individuals might develop various addictions. If this is the case – and I believe that it is – where does that leave the ‘addictive personality’ construct?

‘Addictive personality’ is arguably a ‘one type fits all’ approach and there is now much evidence that the causes of addiction are biopsychosocial from an individual perspective, and that situational determinants (e.g., accessibility to the drug/behaviour, advertising and marketing, etc.) and structural determinants (e.g., toxicity of a specific drug, game speed in gambling, etc.) can also be influential in the aetiology of problematic and addictive behaviours. Another problem with ‘addictive personality’ being an explanation for why individuals develop addictions is that the concept inherently absolves an individual’s responsibility of developing an addiction and puts the onus on others in treating the addiction. Ultimately, all addicts have to take some responsibility in the development of their problematic behaviour and they have to take some ownership for overcoming their addiction. Personally, I believe it is better to concentrate research into risk and protective factors of addiction rather than further research of ‘addictive personality’.

As I have argued in a number of my papers and book chapters, not every addict has a personality disorder, and not every person with a personality disorder has an addiction. While some personality disorders appear to have an association with addiction including Antisocial Personality Disorder and Borderline Personality Disorder, just because a person has some of the personality traits associated with addiction does not mean they are, or will become, an addict. Practitioners consider specific personality traits to be warning signs, but that’s all they are. There is no personality trait that guarantees an individual will develop an addiction and there is little evidence for an ‘addictive personality’ that is predictive of addiction alone. In short, ‘addictive personality’ is a complete myth.

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.

Conway, K. P., Kane, R. J., Ball, S. A., Poling, J. C., & Rounsaville, B. J. (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence, 71(1), 65-75.

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

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. (2009). The psychology of addictive behaviour. In: M. Cardwell, M., L. Clark, C. Meldrum & A. Waddely (Eds.), Psychology for A2 Level (pp. 236-471). London: Harper Collins.

Griffiths, M.D. (2017). The myth of ‘addictive personality’. Global Journal of Addiction and Rehabilitation Medicine, 3(2), 555610.

Hittner, J. B., & Swickert, R. (2006). Sensation seeking and alcohol use: A meta-analytic review. Addictive Behaviors, 31(8), 1383-1401.

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.

MacLaren, V. V., Fugelsang, J. A., Harrigan, K. A., & Dixon, M. J. (2011). The personality of pathological gamblers: A meta-analysis. Clinical Psychology Review, 31(6), 1057-1067.

Malouff, J. M., Thorsteinsson, E. B., Rooke, S. E., & Schutte, N. S. (2007). Alcohol involvement and the Five-Factor Model of personality: A meta-analysis. Journal of Drug Education, 37(3), 277-294.

Munafo, M. R., Zetteler, J. I., & Clark, T. G. (2007). Personality and smoking status: A meta-analysis. Nicotine & Tobacco Research, 9(3), 405-413.

Nakken, C. (1996). The addictive personality: Understanding the addictive process and compulsive behaviour. Hazelden, Center City, MN: Hazelden.

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

Pols, R. G. (1984). The addictive personality: A myth. Australian Alcohol/Drug Review, 3(1), 45-47.

Sadava, S.W. (1978). Etiology, personality and alcoholism. Canadian Psychological Review/Psychologie Canadienne, 19(3), 198-214.

Szalavitz M (2016). Unbroken brain: A revolutionary new way of understanding addiction. St. Martin’s Press, New York.

Szalavitz M (2016). Addictive personality isn’t what you think it is. Scientific American, April 5.

Term warfare: Another look at ‘behavioural addiction’ and ‘selfitis’ as constructs

I recently published a response to a debate article by Dr. Vladan Starcevic and his colleagues in the Australian & New Zealand Journal of Psychiatry. Unfortunately, my response was restricted to a stringent word limit so I am using my personal blog to provide the original version of my response before it was edited. My published version can be found here. Below is the original version:

The article by Starcevic, Billieux and Schimmenti (2018) made a number of assertions concerning my research with various co-authors. While I am always grateful that my work is being read and cited, some of the assertions made were arguably unfair, misguided and/or not stated in context (and could therefore be construed as untrue). In this short article, I first address some of the claims made about our research into the construct of ‘selfitis’. I then address a few of the wider issues made by Starcevic et al. in relation to behavioural addictions more generally because they used some of my other research into various behavioural addictions to make their arguments.

The construct of ‘selfitis’

Starcevic et al. noted that there has been a trend “to medicalize problematic behaviours” (p.1) and used the example of ‘selfitis’ to make their point. The way the article was written it would appear to the naïve reader that I and my co-author (Janarthan Balakrishnan) had coined the term ‘selfitis’. For instance, the article by Starcevic et al. cites our paper in specific reference to the following assertion:

“Instead of labelling an excessive and sometimes dangerous practice of taking selfies a ‘selfie addiction’, this behaviour was conceptualised as an inflammation-like selfitis (Balakrishnan and Griffiths, in press)”.

This sentence clearly gives the impression that it was Dr. Balakrishnan and I who conceptualised ‘selfitis’ and that our conceptualisation was that it was “inflammation-like”. However, we made it very clear to readers in the very first paragraph of our paper that the concept of ‘selfitis’ originally started a hoax claiming that the ‘disorder’ was to be included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The original hoax report defined selfitis as “the obsessive compulsive desire to take photos of one’s self and post them on social media as a way to make up for the lack of self-esteem and to fill a gap in intimacy” which we again made clear in the second sentence of our paper. The two studies in our paper were exploratory and merely set out to examine whether there were individuals who were ‘obsessive selfie-takers’. In many parts of their article, Starcevic et al. appear to insinuate that our paper equates ‘selfitis’ with ‘selfie addiction’. For instance, they wrote:

“Interestingly, the components of selfitis that were identified (environmental enhancement, social competition, attention seeking, mood modification, self-confidence and subjective conformity) have practically nothing in common with behavioural addiction…Therefore, selfitis appears to be a construct that is very different from ‘selfie addiction’, and its purported link with compulsivity also seems tenuous” (p.1).

The six components comprising selfitis in our new psychometric tool (the Selfitis Behavior Scale [SBS]) were correctly reported but at no point in our paper did we ever say that ‘selfitis’ was a behavioural addiction. What we did write was that (a) “selfitis is a new construct in which future researchers may investigate further in relation to selfitis addiction and/or compulsion” (p.8), and (ii) “the qualitative focus group data from participants strongly implied the presence of ‘selfie addiction’ although the SBS does not specifically assess selfie addiction” (p.11). They also noted that our published paper on selfitis:

“…did not go unnoticed by the media, always ready to exploit everything that is ‘novel’ and sensational. Thus, one newspaper reported that selfitis, ‘the obsessive need to post selfies’, was a ‘genuine mental disorder’ and quoted one of the authors of the aforementioned article that the existence of selfitis appeared to be confirmed (www.telegraph.co.uk/science/2017/12/15/selfitis-obsessiveneed-post-selfies-genuine-mental-disorder/)…The word has thus become enriched by one more ‘condition’, complete with an assessment tool to establish its severity and a suggestion that people with selfitis may need professional help” (p.2).

While it is true that our study did not go unnoticed by the media (and was reported in hundreds of news stories around the world), only one newspaper journalist ever interviewed me about the study and at no point either in our published paper or in any conversations with the broadcast media did we ever say that ‘selfitis’ was a mental disorder. Our paper simply concluded that obsessive selfie-taking was a condition that appears to exist and made the observation that selfitis has “psychological consequences (which may be both positive and negative)” (p.12). In fact, we talked about the positive aspects of selfitis throughout the discussion section of our paper. In short, I would like it to be made clear that (i) we did not coin the term ‘selfitis’, (ii) we have never anywhere in published print (academic papers or the print media) claimed selfitis is a mental disorder, (iii) we have never claimed selfitis is a behavioural addiction, and (iv) we have never equated ‘selfitis’ with ‘selfie addiction’ (although we have just published another paper briefly reviewing the studies that have examined the concept of ‘selfie addiction’ [i.e., Griffiths & Balakrishnan, 2018]).

The construct of ‘behavioural addiction’

Starcevic et al. also claimed in their article that the term ‘behavioural addiction’ is “vague, misused and applied to an exceptionally wide variety of activities” (p.1). I would argue that the far from being ‘vague’, behavioural addiction has clearly been defined as any addiction that does not involve the ingestion of a psychoactive substance (Griffiths, 1996, 2005). I agree that it is sometimes misused and I have written dozens of populist articles on my personal blog pointing this out. However, I totally disagree that behavioural addiction has been applied to an ‘exceptionally wide variety of activities’. As I noted in a recent paper: “Very few of the thousands of leisure activities that individuals engage in have ever been written about in terms of addiction in peer-reviewed scientific papers” (Griffiths, 2017; p.1719). Starcevic et al. would be hard pushed to name more than about 20 leisure activities that have ever been empirically examined as a possible behavioural addiction. Of the five activities named by Starcevic in an attempt to show the behavioural addiction is being misused three of them were actually just sub-types of more widely researched behavioural addictions (i.e., stock market addiction is a sub-type of gambling addiction, study addiction is a sub-type of work addiction, and dance addiction is a sub-type of exercise addiction) as made clear in my papers on these topics.

Starcevic et al. also noted that a group of scholars (Kardefelt-Winther et al., 2017) “recently made an effort to reach a consensus, promote conceptual rigour and avoid misuse by proposing an open (modifiable) definition of behavioural addiction” (p.1). More specifically, Kardefelt‐Winther et al. provided four exclusion criteria and argued that behaviours should not be classed as a behavioural addiction if:

1. “The behaviour is better explained by an underlying disorder (e.g. a depressive disorder or impulse-control disorder).
2. The functional impairment results from an activity that, although potentially harmful, is the consequence of a willful choice (e.g. high-level sports).
3. The behaviour can be characterized as a period of prolonged intensive involvement that detracts time and focus from other aspects of life, but does not lead to significant functional impairment or distress for the individual.
4. The behaviour is the result of a coping strategy” (p.1710)

I doubt anyone researching in the behavioural addiction would disagree with the third exclusion criterion because to have a genuine behavioural addiction, the behaviour has to comprise significant functional impairment or distress for the individual. However, I would point out that if these criteria were applied to substance abuse, very few substance users would ever be classed as addicted (Griffiths, 2017). More specifically, I have written elsewhere that three of the four exclusion criteria proposed by Kardefelt‐Winther et al. (2017) are simply untenable:

“For instance, it is proposed that any behaviour in which functional impairment results from an activity that is a consequence of wilful choice should not be considered an addiction. I cannot think of a single addictive behaviour that when the person first started engaging in the behaviour (e.g., drinking alcohol, illicit drug-taking, gambling) was not engaged in wilfully…Also, not being classed as an addiction if the behaviour is secondary to another comorbid behaviour (e.g., a depressive disorder) or is used as a coping strategy again means that some other substance addictions (e.g., alcoholism) would not be classed as genuine addictive behaviours using such exclusion criteria because many substance-based addictions are used as coping strategies and/or are symptomatic of other underlying pathologies” (Griffiths, 2017; pp.1718-1719).

Throughout my 30 years of research into behavioural addiction, I have never simply looked at a behaviour and claimed that it cannot be potentially addictive. Using my own operational criteria for what I believe constitutes a genuine addiction (i.e., salience, conflict, tolerance, withdrawal, mood modification, and relapse; Griffiths, 1966, 2005) very few individuals would be classed as being addicted to activities such as sex, work, exercise, or gaming. However, if there is evidence of what I consider to be the core components of addiction in activities that others believe should not be pathologised (e.g., dancing or academic study), I would not choose to ignore such evidence if such activities caused significant functional impairment and distress for the individuals concerned.

References

Balakrishnan, J. & Griffiths, M.D. (2018). An exploratory study of ‘selfitis’ and the development of the Selfitis Behavior Scale. International Journal of Mental Health and Addiction. Epub ahead of print. https://doi.org/10.1007/s11469-017-9844-x

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. (2017). Behavioural addiction and substance addiction should be defined by their similarities not their dissimilarities. Addiction 112: 1718-1720.

Griffiths, M.D. & Balakrishnan, J. (2018). The psychosocial impact of excessive selfie-taking in youth: A brief overview. Education and Health 36(1): 3-5.

Kardefelt-Winther D, Heeren A, Schimmenti A, et al. (2017) How can we conceptualize behavioural addiction without pathologizing common behaviours? Addiction 112: 1709–1715.

Starcevic, V., Billieux, J., & Schimmenti, A. (2018). Selfitis, selfie addiction, Twitteritis: Irresistible appeal of medical terminology for problematic behaviours in the digital age. Australian & New Zealand Journal of Psychiatry, Epub ahead of print. https://doi.org/10.1177/0004867418763532

Painless steal? Another look at shoplifting as an addiction

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

Further reading

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/

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”.

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 21^st 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.

Odds on: Ten ways to help prevent problem gambling

[Please note: The following article was written with Dr. Michael Auer]

Problem gambling has become a major issue in many countries worldwide. In this short article we provide ten ways to help prevent problem gambling.

Raise the minimum age of all forms of commercial gambling to 18 years – Research has consistently shown that the younger a person starts to gamble, the more likely they are to develop gambling problems. Stopping problem gambling in adolescence is a key step in preventing problem gambling in the first place. Any venue or website that hosts gambling games should have effective age verification procedures.

Restrict the most harmful types of gambling – Most research shows that gambling activities which can be gambled on continuously such as slot machines tend to be far more problematic than discontinuous games such as weekly lotteries. More harmful forms of gambling should be restricted to dedicated gambling venues rather than housed in non-dedicated gambling premises (such as supermarkets, cafes, and restaurants).

Educate players to pre-commit when engaging in the most harmful types of gambling – Ideally, the most harmful forms of gambling should have mandatory limit-setting options for players to set their own voluntary time and money limits when playing the games. Gambling operators can also use mandatory loss limits to keep gambling expenditure to a minimum.

Take responsibility for where problem gambling lies – While all individuals are ultimately responsible for their own gambling behaviour, other stakeholders – including the gambling industry – have control over the structural and situational characteristics of gambling products. Government policymakers and legislators have a responsibility to ensure that gambling products are tightly regulated and to ensure that any given jurisdiction has the infrastructure to keep gambling problems to a minimum. Gambling operators are responsible for all advertising and marketing and need to ensure that the content is socially responsible and promotes responsible gambling. Within gambling venues, all practices and procedures should be socially responsible (such as not giving free alcohol while gambling, and no ATM machines on the gaming floor).

Put social responsibility at the heart of gambling operating practice – The most socially responsible gambling operators always puts player protection and harm minimisation at the heart of their business. They need to provide all information about their products so that individuals can make an informed choice about whether to gamble in the first place. They should advertise their products responsibly and provide their clientele with tools to aid responsible gambling, and provide help and guidance for those who think they are developing a gambling problem or have one.

Raise awareness about gambling among health practitioners and the general public – Problem gambling may be perceived as a somewhat ‘grey’ area in the field of health. However, there is an urgent need to enhance awareness about gambling-related problems within the general public and the medical and health professions.

Identify at-risk players – Big Data and Artificial Intelligence are common approaches applied in behavioural analysis across many industries. Online gambling and personalized land-based gambling operators can detect harmful behavioural patterns such as chasing losses or binge gambling. Such players can be excluded from direct marketing, specific types of games, and/or contacted to prevent the development of problem gambling.

Use personalized feedback – Research across many areas such as sports, health behaviour, as well as gambling has shown that personalized feedback can effectively change behaviour. Using behavioural data available in online gambling and personalized land-based venues, gamblers can be informed in real-time about behavioural changes in order to make them more aware and use pre-commitment tools such as limit-setting and/or self-exclusion.   

Set up both general and targeted gambling prevention initiatives – The goals of gambling intervention are to (i) prevent gambling-related problems, (ii) promote informed, balanced attitudes, and choices, and (iii) protect vulnerable groups. The guiding principles for action on gambling are therefore prevention, health promotion, harm reduction, and personal and social responsibility. This includes:

• General awareness raising (e.g. public education campaigns through advertisements on television, radio, newspapers).
• Targeted prevention (e.g. education programs and campaigns for particularly vulnerable populations such as senior citizens, adolescents, ethnic minorities).
• Awareness raising within gambling establishments (e.g. brochures and leaflets describing problem gambling, indicative warning signs, where help for problems can be sought such as problem gambling helplines, referral service, telephone counselling web-based chatrooms for problem gamblers, and outpatient treatment).
• Training materials (e.g. training videos about problem gambling shown in schools, job centres).

Educate and training those working in the gambling industry about problem gambling – All gaming personnel in any gambling establishments from shop retailers to croupiers should receive ongoing training regarding responsible gambling and problem gambling.

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

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M. & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

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

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

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.

Auer, M. & Griffiths, M.D. (2016). Personalized behavioral feedback for online gamblers: A real world empirical study. Frontiers in Psychology, 7, 1875. doi: 10.3389/fpsyg.2016.01875.

Griffiths, M.D. (2017). Evaluating responsible gambling tools using behavioural tracking data. Casino and Gaming International, 31, 41-45.

Griffiths, M.D. (2016). Gambling advertising, responsible gambling, and problem gambling: A brief overview. Casino and Gaming International, 27, 57-60.

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

Griffiths, M.D., Harris, A. & Auer, M. (2016). A brief overview of behavioural feedback in promoting responsible gambling. Casino and Gaming International, 26, 65-70.

Harris, A. & Griffiths, M.D. (2017). A critical review of the harm-minimisation tools available for electronic gambling. Journal of Gambling Studies, 33, 187–221.

Oehler, S., Banzer, R., Gruenerbl, A., Malischnig, D., Griffiths, M.D. & Haring, C. (2017). Principles for developing benchmark criteria for staff training in responsible gambling. Journal of Gambling Studies, 33, 167-186.

Wood, R.T.A. & Griffiths, M.D. (2015). Understanding positive play: An exploration of playing experiences and responsible gambling practices. Journal of Gambling Studies, 31, 1715-1734.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Screenage rampage: What should parents know about videogame playing for children?

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

Further reading

Griffiths, M.D. (2003).  Videogames: Advice for teachers and parents. Education and Health, 21, 48-49.

Griffiths, M.D. (2009). Online computer gaming: Advice for parents and teachers. Education and Health, 27, 3-6.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Griffiths, M.D., Kuss, D.J. & Pontes, H. (2016). A brief overview of Internet Gaming Disorder and its treatment. Australian Clinical Psychologist, 2(1), 20108.

Griffiths, M.D. & Meredith, A. (2009). Videogame addiction and treatment. Journal of Contemporary Psychotherapy, 39(4), 47-53.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

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. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Kuss, D.J. & Griffiths, M.D. (2012). Internet gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

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

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

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

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

Research published in the American Journal of Addictions has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study by Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side effect during withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.

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

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

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

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

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

Further reading

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

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

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

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

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).

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

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

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

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

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