High ringxiety: Fear of missing out, nomophobia, and social networking addiction

(Please note: The following blog was co-written with Dr. Daria Kuss)

Recent research has suggested that high engagement in social networking is partially due to what has been named the ‘fear of missing out’ (FOMO). According to Dr. Andrew Przybylski and colleagues in a 2013 issue of Computers in Human Behavior, FOMO is “a pervasive apprehension that others might be having rewarding experiences from which one is absent”. The same paper also noted that higher levels of FOMO have been associated with greater engagement with Facebook, lower general mood, lower wellbeing, and lower life satisfaction, mixed feelings when using social media, as well as inappropriate and dangerous social networking site (SNS) use (i.e., in university lectures, and whilst driving).

In addition to this, research by Dr. Frederic Gil and his colleagues in a 2016 issue of the Journal of Behavioral Addictions suggests that FOMO predicts problematic SNS use and is associated with social media addiction, as measured with a scale adapted from the Internet Addiction Test and published by Dr. Ursula Oberst and her colleagues in a 2017 issue of the Journal of Adolescence. It has also been debated whether FOMO is a specific construct, or simply a component of relational insecurity, as observed for example with the attachment dimension of preoccupation with relationships in research into problematic Internet use.

The study led by by Dr Oberst comprised 5,280 social media users from several Spanish-speaking Latin-American countries, and found that FOMO predicts negative consequences of maladaptive SNS use. In addition, this study also found that the relationship between psychopathology (as operationalized by anxiety and depression symptoms and assessed via the Hospital Anxiety and Depression Scale) and negative consequences of SNS use were mediated by FOMO, emphasizing the importance of FOMO in the self-perceived consequences of high SNS engagement.

Research published by Dr. Sarah Buglass and colleagues in a 2016 issue of Computers in Human Behavior using 506 UK Facebook users found that FOMO mediates the relationship between high SNS use and decreased self-esteem. Research with psychotherapists working with clients seeking help for their Internet use-related behaviors also suggested that young clients “fear the sort of relentlessness of on-going messaging (…). But concurrently with that is an absolute terror of exclusion” (quote taken from our 2015 book Internet Addiction in Psychotherapy). Taken together, these findings suggest FOMO may be a significant predictor or possible component of potential SNS addiction, a contention that requires further consideration in future research. Further work is needed into the origins of FOMO (both theoretically and empirically), as well as research into why do some SNS users are prone to FOMO and develop signs of addictions compared to those who do not.

Related to both FOMO is the construct of nomophobia. Nomophobia has been defined by Nicola Luigi Bragazzi and Giovanni Del Puente in a 2014 issue of the journal Psychology Research and Behavior Management as “no mobile phone phobia”, i.e., the fear of being without one’s mobile phone. These two scholars have called for nomophobia to be included in the DSM-5. They suggested the following criteria to contribute to this problem constellation: regular and time-consuming use, feelings of anxiety when the phone is not available, “ringxiety” (i.e., repeatedly checking one’s phone for messages, sometimes leading to phantom ring tones), constant availability, preference for mobile communication over face to face communication, and financial problems as a consequence of use. Nomophobia is inherently related to a fear of not being able to engage in social connections, and a preference for online social interaction (which is the key usage motivation for SNSs), and has been linked to problematic Internet use and negative consequence of technology use, further pointing to a strong association between nomophobia and SNS addiction symptoms.

Using mobile phones is understood as leading to alterations in everyday life habits and perceptions of reality, which can be associated with negative outcomes, such as impaired social interactions, social isolation, as well as both somatic and mental health problems, including anxiety, depression and stress. Accordingly, nomophobia can lead to using the mobile phone in an impulsive way, and may thus be a contributing factor to SNS addiction as it can facilitate and enhance the repeated use of social networking sites, forming habits that may increase the general vulnerability for the experience of addiction-related symptoms as a consequence of problematic SNS use.

• (Please note: Material for this blog was taken from the following paper: Kuss, D.J. & Griffiths, M.D. (2017). Social networking sites and addiction: Ten lessons learned. International Journal of Environmental Research and Public Health, 14, 311; doi:10.3390/ijerph14030311)

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

Further reading

Al-Menayes, J. (2016). The Fear of Missing out Scale: Validation of the Arabic version and correlation with social media addiction. International Journal of Applied Psychology, 6(2), 41-46.

Bragazzi, N. L., & Del Puente, G. (2014). A proposal for including nomophobia in the new DSM-V. Psychology Research and Behavior Management, 7, 155-160.

Buglass, S. L., Binder, J. F., Betts, L. R., & Underwood, J. D. M. (2017). Motivators of online vulnerability: The impact of social network site use and FOMO. Computers in Human Behavior, 66, 248-255.

Gil, F., Chamarro, A., & Oberst, U. (2016). Addiction to online social networks: A question of “Fear of Missing Out”? Journal of Behavioral Addictions, 4(Suppl. 1), 51.

Griffiths, M.D. (2013) Social networking addiction: Emerging themes and issues. Journal of Addiction Research and Therapy, 4: e118. doi: 10.4172/2155-6105.1000e118.

Griffiths, M.D. & Kuss, D.J. (2011). Adolescent social networking: Should parents and teachers be worried? Education and Health, 29, 23-25.

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

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental Research and Public Health, 8, 3528-3552. 

Kuss, D.J.; Griffiths, M.D. Internet addiction in psychotherapy; Palgrave: London, 2015;

Oberst, U., Wegmann, E., Stodt, B., Brand, M., & Chamarro, A. (2017). Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence, 55, 51-60.

Przybylski, A. K., Murayama, K., DeHaan, C. R., & Gladwell, V. (2013). Motivational, emotional, and behavioral correlates of fear of missing out. Computers in Human Behavior, 29(4), 1841-1848.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association.

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

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

Griffiths, M.D. & Auer, M. (2013). The irrelevancy of game-type in the acquisition, development and maintenance of problem gambling. Frontiers in Psychology, 3, 621. doi: 10.3389/fpsyg.2012.00621.

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

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

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

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling.  In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

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

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

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

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

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

Feeling hot, hot, hot: A brief look at sex and the sun

Most people now accept that weather can affect mood state and for some people can lead to extreme depression in the form of Seasonal Affective Disorder. There also seems to be some evidence that weather can affect people’s sex lives. Being too hot or too cold is likely to lessen the desire to engage in sexual behaviour. Most academic research appears to indicate that sex drives are higher in spring and summer. One of the reasons given for this is that during spring and summer, there is more sun, and that a particular hormone – Melanocyte Stimulating Hormone (MSH) – stimulates sex, particularly in women.

A number of studies have also indicated that during the spring and summer months, the body produces more seretonin (the so-called ‘feel good neurotransmitter’) because increased luminosity of sunlight. During the winter months as the amount of sunlight decreases, the body produces more melatonin, and this appears to inhibit sex drives. However, there is wide individual variation and the weather and subsequent hormone stimulation differs highly from one person to the next. As an online article by Shiv Joshi confirms:

“Sunlight has a direct effect on the brain’s serotonin production, according to researchers at the Human Neurotransmitter Laboratory and Alfred and Baker Medical Unit, Baker Heart Research Institute, Australia. Our serotonin levels increase with increase in luminosity. And how does that matter? Among other things, serotonin also regulates arousal, says Ray Sahelian, MD, author of Mind Boosters…Not just serotonin, but sunlight affects many other hormones in our body as well, some of which are associated with mood and pleasure feelings, according to professor Carmen Fusco, an instructor in pharmacology. It decreases melatonin, norepinephrine, and acetylcholine and increases cortisol, serotonin, GABA, and dopamine. The summer heat is good for your sex life too. It works on your muscles, by relaxing them and intensifies sensations of the skin. Further, the heat slows us down. This helps us get in touch with our more subdued sensual side, according to psychologist Stella Resnick, PhD, author of The Pleasure Zone”.

German researchers Winfried März and colleagues examined the relationship between vitamin D production (aided by sunny weather) and sex hormones (published a 2010 issue of the journal Clinical Endocrinology). In a study of 2,299 men, the researchers found that levels of Vitamin D were associated with androgen (i.e., testosterone) production with peak levels in August (the sunniest time of year in Germany). They concluded that testosterone and Vitamin D levels “are associated in men and reveal a concordant seasonal variation. Randomized controlled trials are warranted to evaluate the effect of vitamin D supplementation on androgen levels”. The study was replicated by Dr. Katharina Nimptsch and her colleagues among a sample of 1,362 men (also published in the same journal in 2012), and they found the same association between Vitamin D and testosterone production (although they found no seasonal effect). However, a more recent 2014 study published by Dr. Elizabeth Lerchbaim and her colleagues in the journal Andrology found no association (but it was on a much smaller sample of 225 men).

Although I have been unable to track down the academic source, an article by Sam Rider in Coach Magazine claimed that:

 “Exposing the skin to sunlight for just 15-20 minutes can raise your testosterone levels by 120%, says a report from Boston State Hospital in the US. The research also found that the hormone increased by a whopping 200% when genital skin was exposed to the sun. Stick to the privacy of your own garden though – we don’t want any arrests”.

In previous blogs I briefly reviewed some of the many studies into courtship requests by Dr. Nicolas Guéguen (which you can read here and here). In one of his studies (published in a 2013 issue of Social Influence), Guéguen examined the effect of sunshine on romantic relationships (reasoning that sunny weather puts people in a better mood than non-sunny weather). In this study, an attractive 20-year old man approached young women walking alone in the street and asked them for their telephone number in two conditions (sunny or cloudy days). The temperature was controlled for and all days of the experiment were dry. The results showed that more women gave the man their telephone numbers on the sunny days. Guéguen concluded that positive mood induction by the sun may explain the success in courtship solicitation.

Finally, in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, Dr. Aggrawal was quoted as saying that “like allergies, sexual arousal may occur from anything under the sun including the sun”. In fact, Aggrawal’s book arguably contains the most references to fetishes that concern the weather. This includes fetishes and paraphilias in relation to sexual arousal to sunny weather (actirasty), sexual arousal from the cold or winter (cheimaphilia), sexual arousal from snow (chionophilia), sexual arousal from thunderstorms (brontophilia), sexual arousal from thunder and lightning (keraunophilia), sexual arousal from fog (nebulophilia), sexual arousal from rain and being rained upon (ombrophilia and pluviophilia), and love of thunder (tonitrophilia). However, as far as I am aware, no scientific research has ever investigated any of these alleged fetishes.

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

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Amanad, V. (2012). Does weather affect your sex drive? Only My Health, June 29. http://www.onlymyhealth.com/does-weather-affect-your-sex-drive-1340990772

Guéguen, N. (2013). Weather and courtship behavior: A quasi-experiment with the flirty sunshine. Social Influence, 8, 312-319.

Herbert, E. (2009). Sex: Weather-driven desire? Elle, July 28. Located at: http://www.elle.com/life-love/sex-relationships/sex-tips-women

Hurwood, B.J. (1965). The Golden Age of Erotica. Los Angeles, CA: Sherbourne Press.

Joshi, S. (2010). Summer and intimacy: Felling hot, hot, hot. Complete Wellbeing, May 11. Located at: http://completewellbeing.com/article/feeling-hot-hot-hot/

Lerchbaum, E., Pilz, S., Trummer, C., Rabe, T., Schenk, M., Heijboer, A. C., & Obermayer‐Pietsch, B. (2014). Serum vitamin D levels and hypogonadism in men. Andrology, 2(5), 748-754.

Nimptsch, K., Platz, E. A., Willett, W. C., & Giovannucci, E. (2012). Association between plasma 25‐OH vitamin D and testosterone levels in men. Clinical Endocrinology, 77(1), 106-112.

Rider, S. (2015). How to boost your testosterone levels (the natural way). Coach Magazine, October 5. Located at: http://www.coachmag.co.uk/lifestyle/1558/10-ways-boost-testosterone

Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer‐Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology, 73(2), 243-248.

Always being on anon: Social networking as a way of being

(Please note: The following blog was co-written with Dr. Daria Kuss)

In the present day and age, individuals have come to live increasingly mediated lives. Nowadays, social networking does not necessarily refer to what we do, but who we are and how we relate to one another. Social networking can arguably be considered a way of being and relating, and is supported by empirical research. A younger generation of scholars has grown up in a world that has been reliant on technology as integral part of their lives, making it impossible to imagine life without being connected. This has been referred to as an ‘always on’ lifestyle. As Dr. Danah Boyd has asserted “It’s no longer about on or off really. It’s about living in a world where being networked to people and information wherever and whenever you need it is just assumed”.

This has two important implications. First, being ‘on’ has become the status quo. Second, there appears to be an inherent understanding or requirement in today’s technology loving culture that one needs to engage in online social networking in order not to miss out, to stay up to date, and to connect. Boyd herself refers to needing to go on a “digital sabbatical” in order not be on, to take a vacation from connecting, with the caveat that this means still engaging with social media, but deciding which messages to respond to.

In addition to this, teenagers particularly appear to have subscribed to the cultural norm of continual online networking. They create virtual spaces which serve their need to belong, as there appear to be increasingly limited options of analogous physical spaces due to parents’ safety concerns. Being online is viewed as safer than roaming the streets and parents often assume using technology in the home is normal and healthy, as stated by a psychotherapist treating adolescents presenting with the problem of Internet addiction: “Use of digital media is the culture of the household and kids are growing up that way more and more” (quote taken from our 2015 book Internet Addiction in Psychotherapy).

Interestingly, recent research by Winston Teo and his colleagues has demonstrated that sharing information on social media increases life satisfaction and loneliness for younger adult users, whereas the opposite was true for older adult users, suggesting that social media use and social networking are used and perceived very differently across generations. This has implications for social networking addiction because the context of excessive social networking is critical in defining someone as an addict, and habitual use by teenagers might be pathologized using current screening instruments when in fact the activity – while excessive – does not result in significant detriment to the individual’s life.

SNS use is also driven by a number of other motivations. From a ‘uses and gratifications’ perspective, these include information seeking (i.e., searching for specific information using SNS), identity formation (i.e., as a means of presenting oneself online, often more favorably than offline) and entertainment (i.e., for the purpose of experiencing fun and pleasure). In addition to this, there are the motivations such as voyeurism and cyberstalking (see ‘Further reading’ below) that could have potentially detrimental impacts on individuals’ health and wellbeing as well as their relationships.

It has also been claimed that social networking meets basic human needs as initially described in Abraham Maslow’s hierarchy of needs. According to this theory, social networking meets the needs of safety, association, estimation, and self-realization. Safety needs are met by social networking being customizable with regards to privacy, allowing the users to control who to share information with. Associative needs are fulfilled through the connecting function of SNSs, allowing users to ‘friend’ and ‘follow’ like-minded individuals. The need to estimate is met by users being able to ‘gather’ friends and ‘likes’, and compare oneself to others, and is therefore related to Maslow’s need of esteem. Finally, the need for self-realization, the highest attainable goal that only a small minority of individuals are able to achieve, can be reached by presenting oneself in a way one wants to present oneself, and by supporting ‘friends’ on those SNSs who require help.

Consequently, social networking taps into very fundamental human needs by offering the possibilities of social support and self-expression. This may offer an explanation for the popularity of and relatively high engagement with SNSs in today’s society. However, the downside is that high engagement and being always “on” or engaged with technology has been considered problematic and potentially addictive in the past but if being ‘always on’ can be considered the status quo and most individuals are ‘on’ most of the time, where does this leave problematic use or addiction?

• (Please note: Material for this blog was taken from the following paper: Kuss, D.J. & Griffiths, M.D. (2017). Social networking sites and addiction: Ten lessons learned. International Journal of Environmental Research and Public Health, 14, 311; doi:10.3390/ijerph14030311)

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

Further reading

Barker, V. (2009). Older adolescents’ motivations for social network site use: The influence of gender, group identity, and collective self-esteem. CyberPsychology and Behavior, 12, 209-213.

Boyd, D. (2012). Participating in the always-on lifestyle. In M. Mandiberg (Ed.), The Social Media Reader. New York: New York University Press.

Boyd, D. (2014). It’s complicated: The social lives of networked teens. Yale: Yale University Press.

Dressing, H., Bailer, J., Anders, A., Wagner, H., & Gallas, C. (2014). Cyberstalking in a large sample of social network users: Prevalence, characteristics, and impact upon victims. Cyberpsychology, Behavior & Social Networking, 17, 61-67.

Griffiths, M.D. (2013) Social networking addiction: Emerging themes and issues. Journal of Addiction Research and Therapy, 4: e118. doi: 10.4172/2155-6105.1000e118.

Griffiths, M.D. & Kuss, D.J. (2011). Adolescent social networking: Should parents and teachers be worried? Education and Health, 29, 23-25.

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

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental Research and Public Health, 8, 3528-3552.

Kuss, D.J. & Griffiths, M.D. (2015) Internet addiction in psychotherapy. London: Palgrave: London.

Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50, 370-396.

Riva, G., Wiederhold, B. K., & Cipresso, P. (2016). Psychology of social media: From technology to identity. In G. Riva, B. K. Wiederhold & P. Cipresso (Eds.), The psychology of social Networking: Personal experience in online communities (pp. 1-11). Warsaw, Poland: De Gruyter Open.

Teo, W. J. S., & Lee, C. S. (2016). Sharing brings happiness? Effects of sharing in social media among adult users. In A. Morishima, A. Rauber & C. L. Liew (Eds.), Digital Libraries: Knowledge, Information, and Data in an Open Access Society: 18th International Conference on Asia-Pacific Digital Libraries, ICADL 2016, Tsukuba, Japan, December 7–9, 2016, Proceedings (pp. 351-365). Cham: Springer International Publishing.

Zhao, S.Y., Grasmuck, S., & Martin, J. (2008). Identity construction on Facebook: Digital empowerment in anchored relationships. Computers in Human Behavior, 24, 1816-1836.

It takes all sports: A brief look at sport-related betting

Over the past year I have been carrying out research with my Spanish colleague – Dr. Hibai Lopez-Gonzalez – into problematic sports betting and sports betting advertising which has already produced a number of papers (see ‘Further reading’ below) and with many more to come. One of the issues we have faced in contextualising our work is that there is no such concept as sport-related problem gambling in prevalence surveys because problem gambling is assessed on the totality of gambling experiences rather than a single activity. For instance, in the three British Gambling Prevalence Surveys (BGPSs) conducted since 1999, sport-related gambling is subsumed within a number of different gambling forms: ‘football pools and fixed odds coupons’, ‘private betting’, and ‘other events with a bookmaker’. The 2010 BGPS (which I co-authored) included ‘sports betting’ as a category, along with ‘football pools’ (no coupons), ‘private betting’, ‘spread betting’ (which can include both sports or financial trading). In addition, the 2010 BGPS added a new category under online gambling activities to include ‘any online betting’. More recently, the Health Survey for England also introduced a new category: ‘gambling on sports events (not online)’.

Despite these limitations, some evidence can be inferred from gambling activity by gambling type. In 2014, Heather Wardle and her colleagues combined the gambling data from the Health Survey for England and the Scottish Health Survey. They reported that among adult males aged 16 years and over during a 12-month period, 5% participated in offline football pools, 8% engaged in online betting (although no indication was made about whether this only involved sport), and 8% engaged in sports events (not online). The categories were not mutually exclusive so an overlapping of respondents across categories was very likely. A similar rate was found in South Australia in a 2013 report the Social Research Centre with those betting on sports over the past year accounting for 6.1% of the adult population, an increase from the 4.2% reported in 2005.

In Spain, the Spanish Gambling Commission (Direccion General de Ordenacion del Juego [DGOJ] reported that 1.5% of the adult (male and female) population had gambled online on sports in 2015. This is a significantly lower proportion compared with the British data, although the methodological variations cannot be underestimated. Spanish data also shows that, among those who have gambled online on a single gambling type only, betting on sports is the more prevalent form with up to 66% of those adults.

In France, the data on the topic only focuses on those who gamble rather than examining the general population of gamblers and non-gamblers. Among online gamblers, Dr. Jean-Michel Costes and colleagues reported in a 2011 issue of the journal Tendances that 35.1% had bet on sports during the last 12 months. In another French study by Costes and colleagues published in a 2016 issue of the Journal of Gambling Studies, sports betting represented 16.4% of the gambling cohort, although again, the representativeness of sports betting behaviour among the general gambling and non-gambling population could not be determined.

Due to the aforementioned shortcomings in the definition of sport-related gambling, there is only fragmented empirical evidence concerning the impact of sports-related problem gambling behaviour. For instance, in 2014, Dr. Nerilee Hing noted that clinical reports indicate that treatment seeking for sports-related problem gambling had grown in Australia. In British Columbia (Canada), a 2014 survey by Malatests & Associates for the Ministry of Finance reported that 23.6% of at-risk or problem gamblers had gambled on sports either offline or online. A smaller proportion (16.2%) was found in the Spanish population screened in the national gambling DGOJ survey, except this subgroup was entirely composed of online bettors.

In a 2011 study published in International Gambling Studies with patients from a pathological gambling unit within a community hospital in Barcelona, Dr. Susana Jiménez-Murcia and her colleagues found that among those who had developed the disorder gambling online only (as opposed to those who gamble both online/offline or offline only), just over half (50.8%) were sport bettors. Those who gambled online only (on any activity) and those that only gambled online on sports events represented a small minority of the total number of problem gamblers. Overall, there is relatively little research on this sub-group of gamblers therefore I and others will be monitoring the evolution of this trend as the online gambling population grows.

(Note: This blog was co-written with input from Dr. Hibai Lopez-Gonzalez).

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

Further reading

Costes, J-M, Kairouz, S., Eroukmanoff, V., et al. (2016) Gambling patterns and problems of gamblers on licensed and unlicensed sites in France. Journal of Gambling Studies 32(1), 79–91.

Costes, J., Pousset, M., Eroukmanoff, V., et al. (2010). Gambling prevalence and practices in France in 2010. Tendances, 77, 1–8.

DGOJ (2016a) Análisis del perfil del jugador online. Madrid: Ministerio de Hacienda y Administraciones Públicas.

DGOJ (2016b) Estudio sobre prevalencia, comportamiento y características de los usuarios de juegos de azar en España 2015. Madrid: Ministerio de Hacienda y Administraciones Públicas.

Hing, N. (2014) Sports betting and advertising (AGRC Discussion Paper No. 4). Melbourne: Australian Gambling Research Centre.

Jiménez-Murcia S, Stinchfield R, Fernández-Aranda F, et al. (2011) Are online pathological gamblers different from non-online pathological gamblers on demographics, gambling problem severity, psychopathology and personality characteristics? International Gambling Studies 11(3), 325–337.

Lopez-Gonzalez, H., Estevez, A. & Griffiths, M.D. (2017). Marketing and advertising online sports betting: A problem gambling perspective. Journal of Sport and Social Issues, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2016). Is European online gambling regulation adequately addressing in-play betting advertising? Gaming Law Review and Economics, 20, 495-503.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). Understanding the convergence of online sports betting markets. International Review for the Sociology of Sport, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). ‘Cashing out’ in sports betting: Implications for problem gambling and regulation. Gaming Law Review and Economics, in press.

Malatests & Associates Ltd (2014). 2014 British Columbia Problem Gambling Prevalence Study. Victoria, Canada: Gaming policy and enforcement branch, Ministry of Finance.

The Social Research Centre (2013) Gambling prevalence in South Australia. Adelaide, Australia: Office for problem gambling. Available from: http://phys.org/news/2012-03-lung-doctors-respiratory-diseases-worsen.html.

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, Seabury C, Ahmed H, et al. (2014) Gambling behaviour in England & Scotland. Findings from the health survey for England 2012 and Scottish health survey 2012. London: NatCen Social Research.

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

Tongue-tied: A look inside the weird world of Japanese doorknob licking

Over the past three years or so, I have written a number of articles on various aspects and practices of Japanese sexual culture. These have included Oshouji (i.e., a calligraphy fetish where the decorative writing is done on a person’s – usually naked – body), Hentai (i.e., Japanese hardcore Manga cartoon pornography), Nyotaimori (i.e., eating a variety of foods or a whole meal off somebody’s naked body), Tamakeri (i.e., the masochistic practice of getting sexual pleasure and arousal from being kicked in the testicles), Burusera (i.e., Japanese shops that sell [amongst other things] soiled female undergarments and fetishist school uniforms), Omorashi (i.e., deriving sexual pleasure from having a full bladder or a sexual attraction to someone else experiencing the discomfort of a full bladder) and Shokushu Goukan (i.e., tentacle rape).

About 18 months ago, I came across the Art-Sheep website featuring loads of photographs of young Japanese women licking doorknobs. At first I thought it was some kind of spoof website but after a few hours of online research I realised that it was not a joke, and that there were a fair few articles examining the behaviour. For instance, an article on the Cracked website (‘The 6 Most Bizarre Safe For Work Fetishes’) claimed that the explanation for such sites was “straightforward” and that the Japanese pornography censorship laws are so draconian that it forces Japanese “to be more creative about what they masturbate to”. The article claimed:

“Anybody with a porn addiction can tell you, in order to keep things fresh, you have to get a bit weird. Japan, always on the cutting edge of innovation, simply took this idea and ran with it all the way to Planet Dick Tentacle, which brings us to these images of girls licking doorknobs…Men (and presumably some women) get turned on by the sight of females licking anything. The curse of being a woman is knowing that you can’t eat an ice cream cone or a banana in public without several nearby males achieving a state of semi-arousal”.

A number of online articles claim that because of the strict censorship laws in Japan, the country is “infamous for using a wide variety of stand-ins” for penises as there is a “crackdown on the depiction of genitalia” (so swords, fish, vegetables, and – as mentioned briefly above – tentacles, have been used as substitute phallic images). It has also meant that Japanese manga animators and videogame artists have become more innovative in displaying acts of sexuality. The Cracked article also claimed the doorknob licking trend “is a fairly big deal in Japan, even getting featured on national television”. But what is the attraction of seeing women specifically lick doorknobs (beyond the obvious phallic symbolism)? The Cracked article implies that it could be a masochistic act in that the women is typically viewed on her knees seen licking something that arguably has more bacteria on it than most other household items (bar the toilet), and that the act is therefore degrading and humiliating. Of all the images I have seen myself on various websites, all of the Japanese women were fully clothed (although some did appear to pander to clothing and uniform fetishes, such as the young women being dressed in schoolgirl uniforms, or for those with a fetish for spectacles).

A number of articles (such as those in the ‘Further reading’ list below) report that doorknob licking originated from the self-taught Japanese artist Ryuko Azuma renowned for his sexually provocative illustrations (you can check out some of his work here). More bizarrely, the impetus was (according to Azuma) “a drunken tweet…I tweeted that a collection of photos of a girl licking a doorknob [and thought it] would be a big hit”. The tweeted photographs went viral and subsequently featured on a Japanese television show. Azuma collaborated with a young photographer Ai Ehara, and ‘Doorknob Shojo’ (i.e., the ‘Doorknob Girl’) took on a life of its’ own. An article on the Kotaku website noted:

“The settings vary as much as the doorknobs, from nondescript apartments to crumbling Showa-era dwellings. The doors are typically closed, and the rooms are shut. The other side cannot be penetrated by the viewer, making the pictures, even when they are outside, closed. Some models play to the camera, other don’t. These are private moments, though, and the viewer is a fly on the wall – or door. Tropes that commonly appear in anime, manga, and video games populate the pictures. Some of the girls are wearing schoolbags or carrying phallic recorders and school notebooks. Some of the girls are in school uniforms. Others are dressed like female office workers and even have wear worker name badges around their necks. In Japan, where clothes were traditionally used to mark class and status, these are all identifiers and are used to provide enough information for the viewer to finish the story, making them as an essential part of the narrative. All of these items are meaningless alone. It’s the viewer, informed by popular culture like anime, TV, and games as well as real life, that gives them meaning”.

The photos appeared on Tumblr and featured Ehara herself. (You can have a look at the Tumblr photographs here). Following the viral success of the original photographs, Azuma and Ehara hired and photographed a number of models with their mouths on doorknobs and licking them. As the article in Kotaku noted:

“The photos depict a variety of young girls (shojo) with their mouths and tongues touching doorknobs. The imagery is sexually charged. Doorknobs are ubiquitous and common, bland and banal. Intrinsically, doorknobs are not sexual objects in the same way that, say, a banana is. Yet, their position on a door, require the girls to kneel and by placing their mouths on the knobs. It’s undeniably submissive. A doorknob is not necessarily a sexual object. Its purpose is to open doors. Licking is not only a sexual act. Its purpose is to taste. The juxtaposition comes across as titillation and provocative, designed to elicit a response. The photos might look submissive, or exploitive, but they confront the viewer, asking the question, ‘What do you see?’ The pictures can dominate and even exploit the viewer’s notions of foreplay. The photos are psychosexual, with the viewer, if he or she so chooses, filling in the blanks and replacing the boring with the sensual. For such a commonplace object, the doorknob is a perfect phallic symbol. Like [penises], doorknobs come in a variety of shapes and sizes, from short and fat to long and thin. And like [penises], doorknobs can transmit diseases”.

It’s hard to assess who accesses and enjoys such photos and I know of no non-Japanese sites that have featured such models. I’ll leave you with a quote from Azuma himself who claims that it is up to the person viewing to interpret his art:

“Basically, we shot whatever doorknobs were at the location. But just in case, I always carried a backup knob with me to switch out. I always think a work is completed by the viewer. So whatever the viewer brings to the work is sufficient…Many people feel like the photos are a metaphor for oral sex, but we’re not especially taking the photos with that in mind. See whatever you want to see”.

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

Further reading

Art-Sheep (2015). “Doorknob girl”: Japan and the trend of girls licking doorknobs. August 17. Located at: http://art-sheep.com/doorknob-girl-japan-and-the-trend-of-girls-licking-doorknobs/

Ashcraft, B. (2011). The art of girls licking doorknobs. Kotaku, August 9. Located at: http://kotaku.com/5838276/the-art-of-girls-licking-doorknobs/

The Chive (2015). Leave it to Japan to create the weirdest trend EVER. May 1. Located at: http://thechive.com/2012/01/05/leave-it-to-japan-to-create-the-weirdest-trend-ever-35-photos/

Ntumy, E.K. (2013). The 6 most bizarre safe for work fetishes. Cracked, November 2. Located at: http://www.cracked.com/article_20691_the-6-most-bizarre-safe-work-fetishes.html

Pam (2012). Crazy Japanese trends – Hard to resist? Imperfect Women, March 1. Located at: http://imperfectwomen.com/crazy-japanese-trends-–-hard-to-resist/

Sumitra (2012). Girls licking doorknobs – more madness from Japan. Oddity Central, January 13. Located at: http://www.odditycentral.com/pics/girls-licking-doorknobs-more-madness-from-japan.html

Games without frontiers: A brief look at the psychology of play

In a previous blog I examined my favourite board game (Scrabble) and the extent to which someone could become addicted to it. Today’s blog takes a broader look at the psychology of play more generally. Arguably, many of the topics that I research involve the psychology of playing games with video games and gambling games being my two most obvious areas of interest.

It’s been argued by myself (and others) that the ritualized play of several childhood games provides ‘training’ in the acquisition of gambling behaviour and that some games are pre-cursors to actual gambling (e.g., playing marbles, card flipping, etc.). Some authors (such as Igor Kusyszyn) hold the view that gambling is in itself ‘adult play’. Unsurprisingly, Freud was one of the first people to concentrate on the ‘functions’ of play and concluded that play in all its varieties (a) provides a wish-fulfilment, (b) leads to conflict reduction, (c) provides temporary leave of absence from reality, and (d) brings about a change from the passive to the active.

Since Freud, most psychologists have concentrated on the idea of ‘conflict reduction’ and in doing so have ignored his other three postulations. A more modern approach in the 1970s by Mihalyi Czikszentmihalyi asserted that during play a person can “concentrate on a limited stimulus field, in which he or she can use skills to meet clear demands, thereby forgetting his or her own problems and separate identity” (and provides one of the reasons that a small minority of people can develop problems playing games). Seminal research on the sociology of play by Roger Caillois states notes that play is a “free and voluntary activity”, “a source of joy and amusement” and “bounded by precise limits of time and space” whereas Erving Goffman views it as a “world building activity”.

Games provide the opportunity to prove one’s superiority, the desire to challenge and overcome an obstacle, and a medium by which to test one’s skill, endurance and ingenuity. Games, unlike some activities (including life itself!), tell us whether we have won or lost. As observed by James Smith and Vicki Abt in the 1980s:

“…in the context of a competitive and materialistic culture that has become increasingly regimented and standardized with little room for individual creativity and personal achievement, games (including gambling) offer the illusion of control over destiny and circumstance”.

Perhaps the best categorisation of game types was formulated by Roger Caillois who listed four classifications – agon (competition), alea (chance), mimicry (simulation), and ilinx (vertigo). In the context of games involving gambling, alea and agon are crucial in that they offer a combination of skill, chance and luck. As was previously asserted, most people desire opportunities to test their strength and skill against an adversary, and those games which offer a component of skill or talent combined with luck and chance provide the most favourable conditions. This is particularly prevalent in males who are deemed ‘masculine’ if during the socialization process they show (socially) important traits such as courage, independence, and bravery.

According to Caillois, play is “an occasion of pure waste: waste of time, energy, ingenuity, skill, and often of money” and is a “free and voluntary activity that occurs in a pure space, isolated and protected from the rest of life”. According to Caillois, play is best described by six core characteristics:

• It is free, or not obligatory.
• It is separate (from the routine of life) occupying its own time and space.
• It is uncertain, so that the results of play cannot be pre-determined and so that the player’s initiative is involved.
• It is unproductive in that it creates no wealth and ends as it begins.
• It is governed by rules that suspend ordinary laws and behaviours and that must be followed by players.
• It involves make-believe that confirms for players the existence of imagined realities that may be set against ‘real life’.

Back in 2000, I published an article on the psychology of games in Psychology Review and what makes a good game. I noted that:

• All good games are relatively easy to play but can take a lifetime to become truly adept. In short, there will always room for improvement.
• For games of any complexity there must be a bibliography that people can reference and consult. Without books and magazines to instruct and provide information there will be no development and the activity will die.
• There needs to be competitions and tournaments. Without somewhere to play (and likeminded people to play with) there will be little development within the field over long periods of time.
• Finally – and very much a sign of the times – no leisure activity can succeed today without corporate sponsorship of some kind.

I was recently interviewed by Lucy Orr for an article on board games for The Register – particularly about the psychology of winning. For instance, why is winning so important? I responded to Orr by pointing out that winning makes us feel good both psychologically and physiologically. Winning something – especially if it is a result of something skilful rather than by chance – can feel even better (unless the chance winning is something life changing like winning the lottery). Winning something using your own skill can demand respect from other competitors and brings about esteem (that can feed into one’s own self-esteem). Winning can be a validation that what you are doing is worthwhile. Other parts of my interview were not used.

I was asked whether beating other people makes winning more rewarding? Of course it does. Any time we engage in a behaviour that feels good we want to do it again (and again). Winning can be reinforcing on many different levels. There may be financial rewards, social rewards (peer praise, admiration and respect from others), psychological rewards (feeling better about oneself and feeling that the activity is a life-affirming and life-enhancing activity that feeds into self-esteem), and physiological rewards (increases in adrenaline and serotonin that trigger dopamine and makes us feel happy).

For some people, winning can become addictive. You can’t become addicted to something unless you are constantly reinforced and rewarded for engaging in the behaviour, and (as mentioned above) there are many different types of rewards (e.g., financial, social, psychological and physiological). Any (or all of these) could lead to repetitive and habitual behaviour and in a small minority of cases be addictive. However, as I have noted in a number of my papers, doing something to excess is not addiction. The difference between a healthy excessive enthusiasm and an addiction is that excessive enthusiasms add to life and addictions take away from it. For most people, winning behaviour – particularly in the context of playing board games – will be highly rewarding without being in any way problematic

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

Further reading

Brown, J. (2011). Scrabble addict. Sabotage Times, May 16. Located at: http://sabotagetimes.com/life/scrabble-addict/

Caillois, R. (1961). Man, play and games. Paris: Simon and Schuster.

Csikszentmihalyi, M. (1976). Play and intrinsic rewards. Journal of Humanistic Psychology, 16, 41-63.

Goffman, E. (1967). Interaction Ritual: Essays on face-to-face behavior. Garden City, New York: Doubleday Anchor.

Griffiths, M.D. (2000). The psychology of games. Psychology Review, 7(2), 24-26.

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

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Kusyszyn, I. (1984). The psychology of gambling. Annals of American Academy of Political and Social Sciences, 474, 133-145.

Orr, L. (2016). Winner! Crush your loved ones at Connect Four this Christmas. The Register, December 16. Located at: http://www.theregister.co.uk/2016/12/15/beating_your_family_and_winning_this_christmas/

Smith, J. F. & Abt, V. (1984). Gambling as play Annals of the American Academy of Political and Social Sciences, 474, 122-132.

Walsh, J. (2004). Scrabble addicts. The Independent, October 9. Located at: http://www.independent.co.uk/news/uk/this-britain/scrabble-addicts-535160.html

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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