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Myth world: Addictive personality does not exist
(Please note: This article is a slightly expanded and original version of an article that was first published in The Conversation).
“Life is a series of addictions and without them we die”. This is my favourite quote in the academic addiction literature and was made back in 1990 in the British Journal of Addiction by Professor Isaac Marks. This deliberately provocative and controversial statement was made to stimulate debate about whether excessive and potentially problematic activities such as gambling, sex and work can really be classed as genuine addictive behaviours. Many of us might say to ourselves that we are ‘addicted’ to tea or coffee, our work, or know others who we might describe as having addictions watching the television or using pornography. But is this really true?
The issue all comes down to how addiction is defined in the first place as many of us in the field disagree on what the core components of addiction are. Many would argue that the word ‘addiction’ or ‘addictive’ is used so much in everyday circumstances that word has become meaningless. For instance, saying that a book is an ‘addictive read’ or that a specific television series is ‘addictive viewing’ renders the word useless in a clinical setting. Here the word ‘addictive’ is arguably used in a positive way and as such it devalues the real meaning of the word.
The question I get asked most – particularly by the broadcast media – is what is the difference between a healthy excessive enthusiasm and an addiction and my response is simple – a healthy excessive enthusiasm adds to life whereas an addiction takes away from it. I also believe that to be classed as an addiction, any such behaviour should comprise a number of key components including overriding preoccupation with the behaviour, conflict with other activities and relationships, withdrawal symptoms when unable to engage in the activity, an increase in the behaviour over time (tolerance), and use of the behaviour to alter mood state. Other consequences such as feeling out of control with the behaviour and cravings for the behaviour are often present. If all these signs and symptoms are present I would call the behaviour a true addiction. However, that hasn’t stopped others accusing me of ‘watering down’ the concept of addiction.
A few years ago, Dr. Steve Sussman, Nadra Lisha and I published a large and comprehensive review in the journal Evaluation and the Health Professions examining the co-relationship between eleven different potentially addictive behaviours reported in the academic literature (smoking tobacco, drinking alcohol, taking illicit drugs, eating, gambling, internet use, love, sex, exercise, work, and shopping). We examined the data from 83 large-scale studies and reported an overall 12-month prevalence of an addiction among U.S. adults varies from 15% to 61%. We also reported it plausible that 47% of the U.S. adult population suffers from maladaptive signs of an addictive disorder over a 12-month period, and that it may be useful to think of addictions as due to problems of lifestyle as well as to person-level factors. In short – and with many caveats – our paper argued that at any one time almost half the US population are addicted to one or more behaviours.
There is a lot of scientific literature showing that having one addiction increases the propensity to have other co-occurring addictions. For instance, in my own research I have come across alcoholic pathological gamblers and we can all probably think of individuals that we might describe as caffeine-addicted workaholics. It is also very common for individuals that give up one addiction to replace it with another (which we psychologists call ‘reciprocity’). This is easily understandable as when an individual gives up one addiction it leaves a large hole in the waking lives (often referred to as the ‘void’) and often the only activities that can fill the void and give similar experiences are other potentially addictive behaviours. This has led many people to describe such people as having an ‘addictive personality’.
While there are many pre-disposing factors for addictive behaviour including genetic factors and psychological personality traits such as high neuroticism (anxious, unhappy, prone to negative emotions) and low conscientiousness (impulsive, careless, disorganised), I would argue that ‘addictive personality’ is a complete myth. Even though there is good scientific evidence that most people with addictions are highly neurotic, neuroticism in itself is not predictive of addiction (for instance, there are individuals who are highly neurotic but are not addicted to anything so neuroticism is not predictive of addiction). In short, there is no good evidence that there is a specific personality trait (or set of traits) that is predictive of addiction and addiction alone.
Doing something habitually or excessively does not necessarily make it problematic. While there are many behaviours such as drinking too much caffeine or watching too much television that could theoretically be described as addictive behaviours, they are more likely to be habitual behaviours that are important in an individual’s life but actually cause little or no problems. As such, these behaviours should not be described as an addiction unless the behaviour causes significant psychological and/or physiological effects in their day-to-day lives.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Andreassen, C.S., Griffiths, M.D., Gjertsen, S.R., Krossbakken, E., Kvan, S., & Ståle Pallesen, S. (2013). The relationships between behavioral addictions and the five-factor model of personality. Journal of Behavioral Addictions, 2, 90-99.
Goodman, A. (2008). Neurobiology of addiction: An integrative review. Biochemical Pharmacology, 75(1), 266-322.
Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.
Griffiths, M.D. & Larkin, M. (2004). Conceptualizing addiction: The case for a ‘complex systems’ account. Addiction Research and Theory, 12, 99-102.
Kerr, J. S. (1996). Two myths of addiction: the addictive personality and the issue of free choice. Human Psychopharmacology: Clinical and Experimental, 11(S1), S9-S13.
Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: A meta-analysis. Psychological Bulletin, 136(5), 768-821.
Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.
Marks, I. (1990). Behaviour (non-chemical) addictions. British Journal of Addiction, 85, 1389-1394.
Nakken, C. (2009). The addictive personality: Understanding the addictive process and compulsive behavior. Hazelden, Minnesota: Hazelden Publishing.
Nathan, P. E. (1988). The addictive personality is the behavior of the addict. Journal of Consulting and Clinical Psychology, 56(2), 183-188.
Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 2)
Following on from my previous blog, here are some of my more recent papers with Dr. Edo Shonin and William Van Gordon on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. We are happy for anyone interested in these papers to contact us at the email addresses below.
Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.
- Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on gambling disorder. Recent pilot studies and clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change among individuals with gambling problems. This purpose of this paper is to appraise current directions in gambling disorder research as it relates to mindfulness approaches, and discuss issues that are likely to hinder the wider acceptance of mindfulness as a treatment for gambling disorder. It is concluded that although preliminary findings indicate that there are applications for mindfulness approaches in the treatment of gambling disorder, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed.
Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.
- Although clinical interest has predominantly focused on mindfulness meditation, interest into the clinical utility of Buddhist-derived loving-kindness meditation (LKM) and compassion meditation (CM) is also growing. This paper follows the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines and provides an evaluative systematic review of LKM and CM intervention studies. Five electronic academic databases were systematically searched to identify all intervention studies assessing changes in the symptom severity of Diagnostic and Statistical Manual of Mental Disorders (text revision fourth edition) Axis I disorders in clinical samples and/or known concomitants thereof in sub-clinical/healthy samples. The comprehensive database search yielded 342 papers and 20 studies (comprising a total of 1,312 participants) were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was then used to assess study quality. Participants demonstrated significant improvements across five psychopathology-relevant outcome domains: (i) positive and negative affect, (ii) psychological distress, (iii) positive thinking, (iv) interpersonal relations, and (v) empathic accuracy. It is concluded that LKM and CM interventions may have utility for treating a variety of psychopathologies. However, to overcome obstacles to clinical integration, a lessons-learned approach is recommended whereby issues encountered during the (ongoing) operationalization of mindfulness interventions are duly considered. In particular, there is a need to establish accurate working definitions for LKM and CM.
Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.
- Research into the clinical utility of Buddhist-derived interventions (BDIs) has increased greatly over the last decade. Although clinical interest has predominantly focused on mindfulness meditation, there also has been an increase in the scientific investigation of interventions that integrate other Buddhist principles such as compassion, loving kindness, and “non-self.” However, due to the rapidity at which Buddhism has been assimilated into the mental health setting, issues relating to the misapplication of Buddhist terms and practices have sometimes arisen. Indeed, hitherto, there has been no unified system for the effective clinical operationalization of Buddhist principles. Therefore, this paper aims to establish robust foundations for the ongoing clinical implementation of Buddhist principles by providing: (i) succinct and accurate interpretations of Buddhist terms and principles that have become embedded into the clinical practice literature, (ii) an overview of current directions in the clinical operationalization of BDIs, and (iii) an assessment of BDI clinical integration issues. It is concluded that BDIs may be effective treatments for a variety of psychopathologies including mood-spectrum disorders, substance-use disorders, and schizophrenia. However, further research and clinical evaluation is required to strengthen the evidence-base for existent interventions and for establishing new treatment applications. More important, there is a need for greater dialogue between Buddhist teachers and mental health clinicians and researchers to safeguard the ethical values, efficacy, and credibility of BDIs.
Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.
- This commentary provides an alternative perspective to some of the key arguments and observations outlined by Monteiro and colleagues (2015) concerning the relative deficiency of authenticity in secular mindfulness-based approaches compared with mainstream Buddhist practice traditions. Furthermore, this is achieved by critically examining the underlying assumption that if secular mindfulness-based approaches represent a more ‘superficial’ construction of mindfulness, then the ‘superior’ approach embodied by present-day Buddhist teachers and traditions should be easily identifiable. More specifically, a means of understanding mindfulness (and related Buddhist meditative principles) is presented that attempts to communicate the versatility and underlying unity of the Buddha’s teachings, and the fact that the scriptural, empirical, and logical grounds for asserting that secular mindfulness-based approaches offer a less authentic practice mode than mainstream Buddhist modalities are not as robust as contemporary general opinion might suggest.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.
- In 2014, over 700 scientific papers on mindfulness were published, which is more than double the amount of mindfulness papers published in 2010. Approximately 80% of adults and 70% of General Practitioners in the UK believe that practising mindfulness can lead to health benefits. The most convincing evidence exists for the use of mindfulness-based interventions (MBIs) in the treatment of depression and anxiety. Meta-analytic studies assessing the efficacy of mindfulness as a treatment for these two disorders have typically reported effect sizes in the moderate-strong to strong range. There is increasing evidence suggesting that mindfulness is an effective means of increasing perceptual distance from distressing psychological and somatic stimuli, and that it leads to functional neuroplastic changes in the brain. However, the aforementioned ‘fashionable’ status of mindfulness amongst both the general public and scientific community has likely overshadowed the need to address a number of key methodological and operational issues concerning its treatment efficacy.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, 1, 1-6.
Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Teaching ethics in mindfulness-based interventions. Mindfulness, 6, 1491–1493.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2015). Does mindfulness work? Reasonably convincing evidence in depression and anxiety. British Medical Journal, 351, h6919 doi: 10.1136/bmj.h6919.
Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016). Mindfulness and Buddhist-derived treatment techniques in mental health and addiction settings. In Shonin, E., Van Gordon, W., & Griffiths, M.D. (Eds.), Mindfulness and Buddhist-derived Approached in Mental Health and Addiction (pp. 1-6). New York: Springer.
Van Gordon, W., Shonin, E., Griffiths, M.D., & Singh. N.N. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. (pp. 9-27). New York: Springer.
Van Gordon W., Shonin, E., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Can second generation of mindfulness-based interventions be helpful in treating psychiatric disorders? Australian and New Zealand Journal of Psychiatry, 49, 591-592.
Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.
Van Gordon, W., Shonin, E., Singh. N.N. & Griffiths, M.D. (2015). The mindfulness of emptiness and the emptiness of mindfulness. In: Shonin, E., Van Gordon, W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness (pp. 159-179). New York: Springer.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Are contemporary mindfulness-based interventions unethical? British Journal of General Practice, 66, 94-95.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for individuals with fibromyalgia syndrome: An interpretative phenomenological analysis of participants’ experience. Mindfulness, in press.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Buddhist emptiness theory: Implications for the self and psychology. Psychology of Religion and Spirituality, in press.
Van Gordon, W., Shonin, E., Cavalli, G. & Griffiths, M.D. (2016). Ontological addiction: Classification, aetiology and treatment. Mindfulness, in press.
Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 1)
Over the last year I’ve been receiving a lot of emails (well, about nine or ten to be honest but it seems like a lot) expressing surprise at the increasing numbers of papers on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. This research program is actually being led by my friends and Nottingham Trent University research colleagues, Dr. Edo Shonin and Willliam Van Gordon. Given this increasing level of interest, I thought I would use my next two blogs to briefly overview some of these publications. My research colleagues and I are happy for anyone interested in these papers to contact us at the email addresses below. We also have a new book on the topic too (Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction).
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 806–823.
- There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at three-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.
- Recent decades have witnessed a marked increase in research investigating the etiology, typology, symptoms, prevalence, and correlates of workaholism. However, despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies. Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice. Thus, there is a need to establish dedicated and effective treatments for workaholism. A novel broad-application interventional approach receiving increasing attention by occupational and healthcare stakeholders is that of third-wave cognitive behavioral therapies (CBTs). Third-wave CBTs integrate aspects of Eastern philosophy and typically employ a meditation-based recovery model. A primary treatment mechanism of these techniques involves the regulation of psychological and autonomic arousal by increasing perceptual distance from faulty thoughts and mental urges. A ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience. The purpose of this case study was to conduct the first evaluation of a treatment employing a meditation-based recovery model for a workaholic.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.
- In the last five years, scientific interest into the potential applications of Buddhist-derived interventions (BDIs) for the treatment of problem gambling has been growing. This paper reviews current directions, proposes conceptual applications, and discusses integration issues relating to the utilisation of BDIs as problem gambling treatments. A literature search and evaluation of the empirical literature for BDIs as problem gambling treatments was undertaken. To date, research has been limited to cross-sectional studies and clinical case studies and findings indicate that Buddhist-derived mindfulness practices have the potential to play an important role in ameliorating problem gambling symptomatology. As an adjunct to mindfulness, other Buddhist-derived practices are also of interest including: (i) insight meditation techniques (e.g., meditation on ‘emptiness’) to overcome avoidance and dissociation strategies, (ii) ‘antidotes’ (e.g., patience, impermanence, etc.) to attenuate impulsivity and salience-related issues, (iii) loving-kindness and compassion meditation to foster positive thinking and reduce conflict, and (iv) ‘middle-way’ principles and ‘bliss-substitution’ to reduce relapse and temper withdrawal symptoms. In addition to an absence of controlled treatment studies, the successful operationalisation of BDIs as effective treatments for problem gambling may be impeded by issues such as a deficiency of suitably experienced BDI clinicians, and the poor provision by service providers of both BDIs and dedicated gambling interventions. Preliminary findings for BDIs as problem gambling treatments are promising, however, further research is required.
Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.
- Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.
- Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers and but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.
Contact details
e.shonin@awaketowisdom.co.uk; william@awaketowisdom.co.uk; mark.griffiths@ntu.ac.uk
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Additional input by Edo Shonin and William Van Gordon
Further reading
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2012). The health benefits of mindfulness-based interventions for children and adolescents, Education and Health, 30, 94-97.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 617, 654-654.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness and addiction: Sending out an SOS. Addiction Today, March, 18-19.
Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based therapy: A tool for spiritual growth? Thresholds, Summer, 14-18.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.
Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Meditation Based Awareness Training (MBAT) for psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849–863.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Does mindfulness meditation have a role in the treatment of psychosis? Australian and New Zealand Journal of Psychiatry, 48, 124-127.
Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.
Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Mindfulness and the Social Media, Mass Communication and Journalism, 4: 194. doi: 10.4172/2165-7912.1000194.
Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.
Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.
Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.
Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-392.
Van Gordon, W. Shonin, E.S., Skelton, K. & Griffiths, M.D. (2014). Working mindfully: Can mindfulness improve work-related wellbeing and work? Counselling at Work, 87, 14-19.
Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M.D. (2014). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 12, 806–823.
Target practice: The psychology of New Year’s resolutions and how to keep them
(Please note: This blog is a slightly extended and fully referenced version of an article that was first published in The Conversation).
Academic research by Dr. John Norcross and his colleagues has shown that up to 50% of adults make New Year’s resolutions (NYRs) and the most common resolutions are wanting to lose weight, doing more exercise, quitting smoking, and saving money. It’s a time that individuals want to re-invent themselves but less than 10% actually manage to keep the NYRs after a few months.
We’ve all made NYRs that we begin with the best of intentions but within a few weeks are back to our old ways. As a Professor of Behavioural Addiction I know how easy people can fall into bad habits, and why on trying to give up those habits is easy to relapse. NYRs usually come in the form of lifestyle changes and changing behaviour that has become routine and habitual (even if they are not problematic) can be very hard to break.
The main reason that people don’t stick to their NYRs is that they set too many and/or they are unrealistic to achieve. There has also been some research by Dr. Janet Polivy and Dr. Peter Herman into ‘false hope syndrome’ (FHS) that is applicable to NYRs. FHS is characterized by an individual’s unrealistic expectations about the likely speed, amount, ease, and consequences of changing their behaviour.
For some people, it takes something radical for them to change their ways. It took a medical diagnosis to make me give up alcohol and caffeine, and it took pregnancy for my partner to give up cigarette smoking. To change your day-to-day behaviour you also have to change your thinking. But there are tried and tested ways that can help individuals stick to their NYRs and here are my personal favourites:
Be realistic – You need to begin by making NYRs that you can keep and that are practical. If you want to reduce your alcohol intake because you tend to drink alcohol every day, don’t immediately go teetotal. Try to cut out alcohol every other day or have a drink once every three days. Also, breaking up the longer-term goal into more manageable short-term goals can also be beneficial and more rewarding. The same principle can be applied to exercise or eating more healthily.
Do one thing at a time – One of the easiest ways routes to failure is to have too many NYRs. If you want to be fitter and healthier, do just one thing at a time. Give up drinking. Give up smoking. Join a gym. Eat more healthily. But don’t do them all at once. Chose just one and do your best to stick to it. Once you have got one thing under your control, you can begin a second resolution.
Be SMART – Anyone working in a jobs that includes objective-setting will know that any goal should be SMART (i.e., specific, measurable, achievable, realist and time-bound). NYRs should be no different. Cutting down alcohol drinking is an admirable goal but it’s not SMART. Drinking no more than two units of alcohol every other day for one month is a SMART resolution. Connecting the NYR to a specific aspirational goal can also be motivating (e.g., dropping a dress size or losing two inches off your waistline in time for the next summer holiday).
Tell someone your resolution(s) – Letting family and friends around you know that you have a NYR that you really want to keep will act as both a safety barrier and a face-saver. If you really want to cut down smoking or drinking, real friends will not put temptation in your way and can help you in monitoring your day-to-day behaviour. Never be afraid to ask for help and support from those around you.
Change your behaviour with others – Trying to change habitual behaviour on your own can be difficult. For instance, if you and your partner both smoke, drink and/or eat unhealthily, it is really hard for one partner to change their behaviour if the other is still engaged in the same old bad habits. By having the same NYR (e.g., going on a diet), the chances of success will improve if you are both in it together.
Behavioural change isn’t limited to the New Year – Changing your behaviour (or some aspect of it) doesn’t have to be restricted to the start of the New Year. It can be anytime.
Accept lapses as part of the process – It is inevitable that when trying to give up something (alcohol, cigarettes, junk food) that there will be lapses. You shouldn’t feel guilty about giving in to your cravings but accept that it is part of the learning process in enabling behavioural change. Bad habits can take years to become engrained and there are no quick fixes in making major lifestyle changes. These may be clichés but we learn by our mistakes and every day is a new day and you can start each day afresh. Right here. Right now.
Finally, some of you reading this might think all of this sounds like too much hard work and that it’s not worth making NYRs to begin with. However, research by John Norcross and colleagues has also shown that individuals who make NYRs are ten times more likely to achieve their goals than those that don’t make explicit NYRs. Food for thought (rather than thought for food)!
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Koestner, R. (2008). Reaching one’s personal goals: A motivational perspective focused on autonomy. Canadian Psychology/Psychologie Canadienne, 49(1), 60-67.
Marlatt, G. A., & Kaplan, B. E. (1972). Self-initiated attempts to change behavior: A study of New Year’s resolutions. Psychological Reports, 30(1), 123-131.
Norcross, J. C. (2006). Integrating self-help into psychotherapy: 16 practical suggestions. Professional Psychology: Research and Practice, 37(6), 683-693.
Norcross, J. C., & Mrykalo, M. S. (2002). Auld Lang Syne: Success predictors, change Processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. Journal of Clinical Psychology, 58, 397-405.
Norcross, J. C., Ratzin, A. C., & Payne, D. (1989). Ringing in the New Year: The change processes and reported outcomes of resolutions. Addictive Behaviors, 14(2), 205-212.
Norcross, J. C., & Vangarelli, D. J. (1989). The resolution solution: longitudinal examination of New Year’s change attempts. Journal of Substance Abuse, 1(2), 127-134.
Polivy, J. (2001). The false hope syndrome: Unrealistic expectations of self-change. International Journal of Obesity and Related Metabolic Disorders, 25, S80-84.
Polivy, J., & Herman, C. P. (2000). The False-Hope Syndrome Unfulfilled Expectations of Self-Change. Current Directions in Psychological Science, 9(4), 128-131.
Polivy, J., & Herman, C. P. (2002). If at first you don’t succeed: False hopes of self-change. American Psychologist, 57(9), 677-689.
Beating the habit: A brief look at ‘cane therapy’ as a treatment for addiction
In 2014, I was the resident psychologist on 12-episode television series called Forbidden made for the Discovery Channel. One of the strangest stories that the series reported on was ‘cane therapy’ for the ‘Twisted Treatments’ episode. Before I was interviewed for the story, I had to research the story and was also given some production notes as background material. According to the material I was provided with:
“Caning treatment was pioneered in Siberia by Dr Sergei Speransky a biologist from the Novosibirsk Institute of Medicine who together with Dr Marina Chuhrova released a research report in 2005 on whipping as a therapy. Dr Speransky and Dr Chukhrova developed the medical theory behind caning. Importantly Dr Chukhrova notes that, ‘It is not some warped sado-masochistic activity,’ but has a clear medical purpose. Apparently, there are some sound scientific principles behind these beatings. Namely the theory that pain activates the body’s immune system, causing it to perform much more effectively than under ‘normal circumstances.’ Dr Chukhrova taught [Dr. German Pilipenko] the theory as a student at university and controversially he has taken her theory and put it into practice, combining it with his own unique psychology treatment. 50-year old German Pilipenko has been caning people for nine years. In his spare time German enjoys the blissful serenity of mountain skiing in his local town. But in his professional life German has to bear the yelps, tears and groans of his patients – German canes and whips people for a living. German started to practice cane therapy in a medical clinic in 2004. Though the clinic no longer exists he’s continued the controversial practice as a private psychologist in a rented 14 square meter room in Novosibirsk’s Business Centre”.
Dr. Pilipenko is a psychotherapist and a hypnotist and claims that cane therapy can cure addictions (both chemical addictions such as alcohol and other drug addictions, and behavioural addictions such as sex addiction and work addiction), depression, phobias and neuroses. Along with Dr. Chukhrova, they have successfully treated over 1000 individuals (aged between 17 and 70 years) of their problems. The therapy appears to be arguably similar to primal therapy (which I briefly examined in a previous blog) and according to Pilipenko “can be used as a kind of anti-stress injection”. Via intense caning sessions Pilipenko not only draws physical pain from his clients but also their emotional reactions. It is the release of these emotions (as with primal therapy) is what he believes cures his patients of their addictions, stresses, depression, and anxieties. (If you are a journalist or an artist he offers the therapy free as a way of promoting his therapeutic practice). For the television programme, one of Dr. Pilipenko’s female clients (Anzhelika Alexeyev, a 22-year old, fifth-year medical student) was interviewed. The production notes I was given noted:
“Anzhelika is only at the beginning of her life, but she’s already experienced hardship and emotional difficulties. Receiving a beating from Dr Pilipenko has been her solution. She’s already visited him once but German believes there is more work to be done. [The programme will] follow Anzhelika through pain and tears as she returns for more caning. She also introduces her father to the treatment and we see her bring him for a session…Her first caning experience was at the start of [the] year…Anzhelika had been suffering stress after miraculously surviving a car crash. German’s advice was that ‘she really needed a lashing.’ She agreed. Initially at the start of the session Anzhelika wanted to leave. She suffered through the first beating in tears, though she persisted, knowing the pain was temporary. She believes the treatment has been successful in curing her trauma and stress related to the accident. In fact she is a big supporter of German’s caning and believes it helps to get rid of emotions that are deeply hidden, unacknowledged and out of control”.
Many newspaper reports have covered the ‘therapy’ over the last few years but nothing has been published on it in peer-reviewed scientific journals. According to one report on the Alternet news site:
“Practitioners Dr. German Pilipenko and Professor Marina Chukhrova say that their treatment is grounded in science: ‘We cane the patients on the buttocks with a clear and definite medical purpose’…The pair say that addicts suffer from a lack of endorphins, and that pain can stimulate the brain to release the feel-good chemicals, ‘making patients feel happier in their own skins.’ Mainstream doctors dismiss the practice, saying that exercise, acupuncture, massage, chocolate or sex are all better at stimulating endorphin secretion. Dr. Pilipenko admits, ‘we get a lot of skepticism…but so do all pioneers.’ The Siberian Times reports that ‘the reaction of most people is predictable: to snigger, scoff or make jokes loaded with sexual innuendo.’ And one recipient of the treatment, 41-year-old recovering alcoholic Yuri, says his girlfriend accused him of simply visiting a dominatrix. But he adds that although ‘the first strike was sickening…Somehow I got through all 30 lashes. The next day I got up with a stinging backside but no desire at all to touch the vodka in the fridge. The bottle has stayed there now for a year’.”
The Alternet story also interviewed another patient (Natasha, a 22-year-old recovering heroin addict with several months clean) who had been paying $100 for a two-hour session and claimed:
“I am the proof that this controversial treatment works, and I recommend it to anyone suffering from an addiction or depression. It hurts like crazy – but it’s given me back my life…With each lash, I scream and grip tight to the end of the surgical table. It’s a stinging pain, real agony, and my whole body jolts…I’m not a masochist. My parents never beat me or even slapped me, so this was my first real physical pain and it was truly shocking. If people think there’s anything sexual about it, then it’s nonsense.”
The article reported that Natasha had received 60 strokes of the cane per session (noting that drug addicts get double the number of lashes than alcoholics). Professor Chukhrova was then quoted as saying that extreme care is taken to ensure patient safety, and that:
“The beating is really the end of the treatment. We do a lot of psychological counseling first, and also use detox. It is only after all the counseling, and heart and pain resistance checks, that we start with the beating. [We use willow branches because they] are flexible and can’t be broken nor cause bleeding…If any patients get sexual pleasure from the beatings, we stop immediately…This is not what our treatment is about. If they’re looking for that, there are plenty of other places to go.”
According to Dr Pilipenko, the unusual combination of psychology and corporal-style punishment is designed to train patients in endurance, tolerance and resistance as ways of coping with stress. Pilipenko believes he provides his clients with the tools to deal with stress and problems in their lives. More specifically he claims that:
“Psychological stimulation is aimed to convince a patient that aggression, idleness and depression will cause problems in life…Usually a patient is prescribed three separate visits, before they can be cured but it might be necessary for anything up to 10 sessions, depending on the severity of the individual case”.
Dr. Pilipenko also claims that cane therapy that was practiced by monks in the Middle Ages. However, I also noted that following each caning, his clients receive both psychotherapy and hypnotherapy. This begs the question as to whether it is these additional forms of intervention that are key to therapeutic success rather than the caning in and of itself.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Alternet (2013). Weird science: Siberian psychologists caning patients “on the buttocks” in new addiction treatment. January 7. Located at: http://www.alternet.org/weird-science-siberian-psychologists-caning-patients-buttocks-new-addiction-treatment
Daily News (2014). Russian patients pay therapists to cane them in bizarre treatment. October 2. Located at: http://www.nydailynews.com/life-style/russian-patients-pay-therapists-cane-article-1.1960979
Siberian Times (2013). Beating the addiction out of you – literally. January 7. Located at: http://siberiantimes.com/other/others/features/beating-addiction-out-of-you-literally/
Stewart, W. (2013). How to beat your demons, literally: Siberian psychologists thrash patients with sticks to help them kick their addictions. Daily Mail, January 7. Located at: http://www.dailymail.co.uk/news/article-2258395/How-beat-addictions-literally-Siberian-psychologists-thrash-patients-sticks-help-kick-habits.html
Cured meets: Treating addictive behaviours
Addiction is a highly prevalent problem within today’s society and there is a lot of time and many spent in trying to prevent and treat the behaviour. There has also been a move towards getting addicts motivated to want to change their behaviour. The most influential model worldwide is probably the ‘stages of change’ model by Dr. James Prochaska and Dr, Carlo Di Clemente that identifies an individual’s ‘readiness for change’ and tries to get a person to a position where they are highly motivated to change their behaviour. The individual stages of this model are:
- Precontemplation – This is where the person unaware of the consequences of his or her own behaviour and no change in behaviour is foreseeable.
- Contemplation – This is where the person aware problem exists and is contemplating change.
- Preparation – This is where the person has decided to change in the near future (e.g., New Year resolution).
- Action – This is where the person effects change (e.g., gets rid of all association items related to the behaviour).
- Maintenance – This is where the person consolidates behaviour change over time.
- Relapse – This where the person reverts to a former behaviour pattern (e.g., contemplation, preparation).
People can stay in one stage for a long time and it is also possible for unassisted change such “maturing out” or “spontaneous remission”. Various techniques can be used to help people prepare for readiness include motivational techniques, behavioural self-training, skills training, stress management training, anger management training, relaxation training, aerobic exercise, relapse prevention, and lifestyle modification. The goal of treatment can be either abstinence or simply to cut down.
The intervention and treatment options for the treatment of addiction include, but are not limited to counselling/psychotherapies, behavioural therapies, cognitive-behavioural therapies, self-help therapies, pharmacotherapies, residential therapies, minimal interventions and combinations of these (i.e., multi-modal treatment packages). The most important of these are outlined below.
Pharmacotherapy: Pharmacological interventions basically consist of addicts being given a drug to help overcome their addiction. These are mainly given to those people with chemical addictions (e.g., nicotine, alcohol, heroin, etc.) but are increasingly being used for those with behavioural addictions (e.g., gambling, sex, work, exercise, etc.). For instance, some drugs produce an unpleasant reaction when used in combination with the drug of dependence, replacing the positive effects of the drug of dependence with a negative reaction. For instance, alcoholics are sometimes prescribed disulfiram (more commonly known as Antabuse), that when combined with alcohol may produce nausea and vomiting. Other common therapies include methadone and the use of opioid antagonists (such as nalaxone or naltrexene) for heroin addiction. The methadone prevents withdrawal symptoms, block the effects of heroin use, and decreases craving. The main criticism of all these treatments is that although the symptoms may be being treated, the underlying reasons for the addictions may be being ignored. On a more pragmatic level, what happens when the drug is taken away? Often, the addicts return to their addiction if this is the only method of treatment used.
Behavioural therapy: Behavioural therapies are based on the view that addiction is a learned maladaptive behaviour and can therefore be ‘unlearned’. These have mainly been based on the classical conditioning paradigm and include aversion therapy, in vivo desensitisation, imaginal desensitisation, systematic desensitisation, relaxation therapy, covert sensitisation, and satiation therapy. All of these therapies focus on cue exposure, and relapse triggers (like the sight and smell of alcohol/drugs, walking through a neighbourhood where casinos are abundant, pay day, arguments, pressure, etc.). The theory is that through repeated exposure to ‘relapse triggers’ in the absence of the addiction, the addict learns to stay addiction free in high-risk situations. It could be argued that if the addiction is caused by some underlying psychological problem, (rather than a learned maladaptive behaviour), then behavioural therapy would at best only eliminate the behaviour but not the problem. This therefore means that the addictive behaviour may well have been curtailed but the problem is still there so the person will perhaps engage in a different addictive behaviour instead.
Cognitive-behavioural therapy: A more recent development in the treatment of addictive behaviours is the use of cognitive-behavioural therapies (CBT). There are many different CBT approaches that have been used in the treatment of addictive behaviours including rational emotive therapy, motivational interviewing, and relapse prevention. The techniques assume that addiction is a means of coping with difficult situations, dysphoric mood, and peer pressure. Treatment aims to help addicts recognise high-risk situations and either avoid or cope with them without use of the addictive behaviour. In relapse prevention, the therapist helps to identify situations that present a risk for relapse (both intrapersonal and interpersonal). Relapse prevention provides the addict with techniques to learn how to cope with temptation (positive self statements, decision review, and distraction activities), coupled with the use of covert modelling (i.e., practicing coping skills in one’s imagination). It also provides skills for coping with lapses (by redefining what is happening), and utilizes graded practice (a desensitization technique where addicts encounter real life situations slowly). Overall, CBT approaches are better researched than the other psychological methods in addiction but are probably no more effective (Luty, 2003).
Psychotherapy: Psychotherapy can include everything from Freudian psychoanalysis and transactional analysis, to more recent innovations like drama therapy, family therapy and minimalist intervention strategies. The therapy can take place as an individual, as a couple, as a family, as a group and is basically viewed as a ‘talking cure’ consisting of regular sessions with a psychotherapist over a period of time. Most psychotherapies view maladaptive behaviour as the symptom of other underlying problems. Psychotherapy often is very eclectic by trying to meet the needs of the individual and helping the addict develop coping strategies. If the problem is resolved, the addiction should disappear. In some ways, this is the therapeutic opposite of pharmacotherapy and behavioural therapy (which treats the symptoms rather than the underlying cause). There has been little evaluation of its effectiveness although most addicts go through at least some form of counselling during the treatment process.
Self-help therapy: The most popular self-help therapy worldwide is the Minnesota Model 12-Step Programme (e.g., Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sexaholics Anonymous, etc.). This treatment programme uses a group therapy technique and uses only ex-addicts as helpers. Addicts attending 12-Step groups involves them accepting personal responsibility and views the behaviour as an addiction that cannot be cured but merely arrested. To some it becomes a way of life both spiritually and socially and compared with almost all other treatments it is especially cost-effective (even if other treatments have greater success rates) as the organization makes no financial demands on members or the community. For the therapy to work, the 12-Step Programme asserts that the addict must come to them voluntarily and must really want to stop engaging in their addictive behaviour. Further to this, they are only allowed to join once they have reached “rock bottom”. To date there has been little systematic study of 12-Step groups but drop out rates are very high (typically 80-90%). There are a number of problems preventing evaluation, particularly anonymity, sample bias, and what the criterion for success is. The empirical evidence suggests that self-help support groups’ complement formal treatment options and can support standardized psychosocial interventions.
When examining all the literature on the treatment of addiction, there are a number of key conclusions that can be drawn. These include that: (i) treatment must be readily available, (ii) no single treatment is appropriate for all individuals., (iii) it is better for an addict to be treated than not to be treated, (iv) it does not seem to matter which treatment an addict engages in as no single treatment has been shown to be demonstrably better than any other, (v) a variety of treatments simultaneously appear to be beneficial to the addict, (vi) individual needs of the addict have to be met (i.e., the treatment should be fitted to the addict including being gender-specific and culture-specific), (vi) clients with co-existing addiction disorders should receive services that are integrated, (vii) remaining in treatment for an adequate period of time is critical for treatment effectiveness, (viii) medications are an important element of treatment for many patients, especially when combined with counselling and other behavioural therapies, (ix) recovery from addiction can be a long-term process and frequently requires multiple episodes of treatment, (x) there is a direct association between the length of time spent in treatment and positive outcomes, and (xi) the duration of treatment interventions is determined by individual needs, and there are no pre-set limits to the duration of treatment.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Griffiths, M.D. (1996). Pathological gambling and its treatment. British Journal of Clinical Psychology, 35, 477-479.
Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.
Griffiths, M.D. & H.F. MacDonald (1999). Counselling in the treatment of pathological gambling: An overview. British Journal of Guidance and Counselling, 27, 179-190.
Hayer, T. & Griffiths, M.D. (2015). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition) (pp. 539-558). New York: Kluwer.
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.
Luty, J. (2003). What works in drug addiction? Advances in Psychiatric Treatment, 9, 280–288.
National Institute on Drug Abuse (1999). Principles of drug addiction treatment: A research-based guide. NIDA.
Potenza, M. & Griffiths, M.D. (2004). Prevention efforts and the role of the clinician. In J.E. Grant & M. N. Potenza (Eds.), Pathological Gambling: A Clinical Guide To Treatment (pp. 145-157). Washington DC: American Psychiatric Publishing Inc.
Prochaska, J.O. and DiClemente, C.C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Melbourne, Florida: Krieger Publishing Company
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.
United Nations Office on Drugs and Crime/World Health Organization (2008). Principles of Drug Dependence Treatment: Discussion paper. UN/WHO.
Horticulture clash: Can gardening be addictive?
Back in November 2000, I appeared in numerous tabloid newspapers around the world in a story about ‘gardening addiction’ (such as one in the Daily Mail – ‘Professor says gardening is addictive’). It all began after I was interviewed by a journalist from the New Scientist magazine (Andy Coghlan). Coghlan wanted my reaction to a study published in the journal Biological Psychology led by my friend and colleague, Dr. Gerhard Meyer (with who I later co-edited the book Problem Gambling in Europe in 2009). Meyer and his colleagues had carried out a study on blackjack players and showed that they increased their heart rates while gambling (something that I also found in an earlier study I published on arousal in slot machine gamblers in a 1993 issue of the journal Addictive Behaviors). Meyer’s study also found that blackjack gamblers playing for money also had increased levels of salivary cortisol compared to blackjack gamblers playing for points.
I was asked by Coghlan whether I thought gambling could be a genuine addiction, even though it didn’t involve the ingestion of a psychoactive substance. I systematically went through my addiction components model (salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse) and spent about 15 minutes talking about my research on various behavioural addictions. When the New Scientist article was published, the only quote attributed to me was the following:
“Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction. If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else”.
I had quite deliberately used the example of gardening to make the point that addiction should be assessed by standard addiction criteria and that if any behaviour fulfils all the criteria for addiction it should be classed as such irrespective of what the behaviour is. I also said in my interview with the New Scientist that I had never come across a case of gardening addiction but that it was theoretically possible. The New Scientist story was re-written by many different news outlets around the world. My comments were included in all of these stories. Some of these stories were reported with the focus being on the gambling study (such as the one reported by the BBC which you can read here). Others such as the Daily Mail and the New York Post (NYP) made my comments as the focus of the story. Here is what the NYP reported under the headline ‘Garden-variety junkies hooked on hobby’:
“Before you stop to smell the roses, you might want to think twice. People who enjoy gardening are as physically addicted as junkies and alcoholics, researchers claim. The findings by scientists at Bremen University in Germany are controversial because many experts refuse to believe that behavior can be addictive…The scientists also found the same is true of sex and gambling. They studied gamblers and measured the amounts of a stress hormone linked to addiction. Dr. Gerhard Meyer asked 10 gamblers in a casino to play blackjack, staking their own money. While the volunteers played, Meyer measured changes in their heart rates and levels of the stress hormone cortisol in their saliva. He then asked them to play for points rather than money, as a ‘control’ situation. Both heart rates and cortisol concentrations were markedly higher when the gamblers played for money…People who use addictive narcotics also have increased cortisol levels, which, in turn, can trigger the ‘addiction chemicals’ dopamine and seretonin in the brain. ‘Some people say you can’t have addiction unless you take a substance, but I would argue that gambling taken to excess is an addiction’, psychologist Mark Griffiths said. ‘If you accept that, you then accept that sex, computer games, even gardening, can be addictive. It opens up the floodgates to everything else’. If the new research is correct, gardening, gambling and sex, which involve pleasurable rewards for effort expended, could set up an addictive chemical pathway in the brain…Meyer says his findings might reduce the culpability of people who have committed crimes. If lawyers can attribute their clients’ crimes to physiological cravings rather than acts of free will, they may receive lighter sentences, he says”.
I spent much of the week in the media trying to get what I had actually said into context (and even appeared on Channel 4’s Big Breakfast television show defending what I had said). The Daily Mail article had sought comment from TV’s most high profile gardening expert Alan Titchmarsh who said: “[Gardening] is a very addictive pursuit. Once you’ve discovered the thrill of making things grow, you can’t stop. I get very twitchy if I can’t get outside and garden for a few days. It is an addiction – but a positive, useful addiction”. While I have no doubt Titchmarsh believed gardening to be a positive addiction (and would fulfil Dr. Bill Glasser’s criteria for positive addiction that I examined in a previous blog), it wouldn’t be an addiction using my own criteria. I wrote a letter to the New Scientist that they published on November 22 (2000) under the title ‘All kinds of addiction’. In that letter I wrote:
“My alleged comments about gardening addiction have been taken totally out of context and I would like to set the record straight, particularly as many of the national media appeared to have had a laugh at my expense following your press release on this story. My comments were made in reaction to the research by Meyer on gambling addiction, and whether I thought gambling was a true addiction because it didn’t involve a drug. I replied that any behaviour, be it gambling, sex, eating, Internet use, playing computer games or even, theoretically, gardening, that features all the core components of addiction, that is to say, mood-modifying effects, withdrawal symptoms, build-up of tolerance, total preoccupation with the activity, loss of control, neglect of everything else in their lives and relapse can be classed as an addiction. This was not reported in your article, leaving me wide open to misinterpretation. For the record, I have never said that gardening is addictive. What I have said is that any behaviour that fulfils the criteria for addiction can be operationally defined as addiction”.
On the same day (November 22), the Daily Mail also published an edited version of the letter I sent to the New Scientist buried away on page 73 (which you can read here) under the title ‘Eh, not quite’. In retrospect, I can smile about the whole incident, but I wasn’t smiling at the time. In a 2005 paper in the Journal of Substance Use, I subtly included a reference to the ‘gardening addiction’ story (or rather the lack of it) in a paper examining the nature of addiction:
“It is also important to acknowledge that the meanings of ‘addiction’, as the word is understood in both daily and academic usage, are contextual, and socially constructed (Howitt, 1991; Irvine, 1995; Truan, 1993). We must ask whether the term ‘addiction’ actually identifies a distinct phenomenon – something beyond problematic behaviour – whether socially constructed or physiologically based. If so, what are the principal features of this phenomenon? If we argue that it is hypothetically possible to be addicted to anything, it is still necessary to account for the fact that many people become addicted to alcohol but very few to gardening. Implicit within our understanding of the term ‘addiction’ is some measure of the negative consequences that must be experienced in order to justify the use of this word in its academic or clinical context. It seems reasonable at this stage to suggest that a combination of the kinds of rewards (physiological and psychological) and environment (physical, social and cultural) associated with any particular behaviour will have a major effect on determining the likelihood of an excessive level of involvement in any particular activity”.
I have still to come across anyone that I would say is genuinely addicted to gardening. However, I did come across an interesting paper on unusual compulsive behaviours caused by individuals receiving medication for Parkinson’s disease. The paper was published in a 2007 issue of the journal Parkinsonism and Related Disorders by Dr. Andrew McKeon and his colleagues. They reported seven case studies of unusual compulsive behaviours after treating their patients with dopamine agonist therapy (i.e., treatment that activates dopamine receptors in the body). One of the cases involved a man who developed a gardening compulsion:
“A 53-year-old male with [Parkinson’s disease] for 13 years became intensely interested in lawn care. He would use a machine to blow leaves for 6 [hours] without rest, finding it difficult to disengage from the activity, as he found the repetitive behavior soothing. He also developed compulsive gambling”.
This case study at least suggests that someone can develop addictive and/or compulsive like behaviour towards gardening but is obviously isolated and very rare (and in this case brought on by the medication taken). I am not aware of any empirical research on gardening addiction since my comments on the topic back in 2000. However, I still stick to my assertion that if the rewards are present (i.e., psychological, social, physiological, and/or financial), it is theoretically possible for people to become addicted to almost anything – even gardening.
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Glasser, W. (1976). Positive Addictions. New York, NY: Harper & Row.
Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.
Griffiths, M.D. (1993). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.
Griffiths, M.D. (2000). All kinds of addiction New Scientist, November 22, p 58.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Hoffmann, B. (2000). Garden-variety junkies ‘hooked’ on hobby: Study. New York Post, November 10. Located at: http://nypost.com/2000/11/10/garden-variety-junkies-hooked-on-hobby-study/
Howitt, D. (1991). Concerning Psychology. Milton Keynes: Open University Press.
Irvine, J. M. (1995). Reinventing perversion: Sex addiction and cultural anxieties. Journal of the History of Sexuality, 5, 429–450.
Meyer, G., Hauffa, B. P., Schedlowski, M., Pawlak, C., Stadler, M. A., & Exton, M. S. (2000). Casino gambling increases heart rate and salivary cortisol in regular gamblers. Biological Psychiatry, 48(9), 948-953.
Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.
McKeon, A., Josephs, K. A., Klos, K. J., Hecksel, K., Bower, J. H., Michael Bostwick, J., & Eric Ahlskog, J. (2007). Unusual compulsive behaviors primarily related to dopamine agonist therapy in Parkinson’s disease and multiple system atrophy. Parkinsonism & Related Disorders, 13(8), 516-519.
Truan, F. (1993). Addiction as a social construction: A postempirical view. Journal of Psychology, 127, 489-499.
Let’s get physical: Exercise addiction (revisited)
At present, exercise addiction is not officially recognised in any medical or psychological diagnostic frameworks such as the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) or the World Health Association’s International Classification of Diseases. However, there has been a lot of research into whether exercise can be classed as a bona fide addiction. In spite of the widespread usage of the term ‘exercise addiction’ there are many different terminologies that describe excessive exercise syndrome. Such terms include ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Exercise addiction has been conceptualised as a behavioural addiction. The symptoms and consequences of exercise addiction have often been characterised by six common components of addiction: salience, mood modification, tolerance, withdrawal symptoms, personal conflict, and relapse.
For some people, exercise addiction is a primary problem in the person’s life whereas in others it can be a secondary problem as a consequence of other psychological dysfunctions (like eating disorders such as anorexia nervosa). In the former case, the dysfunction is considered as primary exercise addiction, while in the latter case it is termed as secondary exercise addiction because it co-occurs with another dysfunction. The differentiating feature between the two is that in primary exercise addiction the objective is the exercise itself, whereas in secondary exercise addiction the objective is weight loss, where excessive exercise is one of the primary means in achieving the desired objective.
The incentive or motive for fulfilling planned exercise is an important distinguishing characteristic between addicted and nonaddicted exercisers. The reason people exercise is often for an intangible reward such as feeling in shape, looking good, being with friends, staying healthy, building muscles, losing weight, etc. The personal experience of the anticipated reward reinforces and strengthens the exercise behaviour. Committed exercisers maintain their exercise for benefiting or gaining from their activity and thus, their behaviour is motivated via positive reinforcement. However, empirical research has demonstrated that addicted exercisers have to exercise in order to avoid negative feelings or withdrawal. The individual’s exercise may become a chore that has to be fulfilled, or otherwise an unwanted event would occur (such as the inability to cope with stress, or gaining weight, becoming moody, etc.). Every time a person undertakes behaviour to avoid something negative, bad, and/or unpleasant, the motive behind that behaviour acts as a negative reinforcement. In these situations, the person feels they have to do it rather than wanting to do it.
Mood modification is a key factor among the symptoms of exercise addiction and suggests there is a self-medication aspect of exercise that facilitates the distinction between normal and abnormal exercise. Addicts do not simply exercise to experience the joy of it, but rather to escape negative, unpleasant feelings and everyday difficulties.
The Exercise Addiction Inventory is one of the most recent and most widely used screening tools in the research area of exercise addiction, primarily because of its brevity and excellent psychometric properties (i.e., reliability and validity). The EAI comprises only six statements, each corresponding to one of the symptoms in the ’components’ model of addiction. Each statement is rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The EAI cut-off score for individuals considered at-risk of exercise addiction is 24 out of 30. To date, the only nationally representative study examining exercise addiction is a study that I co-authored with some Hungarian colleagues. We surveyed over 2,700 Hungarian adults aged 18–64 years and assessed exercise addiction using the EAI. Results showed that the proportion of the people at risk for exercise addiction was 0.5%.
There are numerous theories that deal with both the causes of exercise addiction and the process and mechanisms of its development and maintenance. A significant number of psychological theories are based on learning theory or the cognitive psychology approach. According to the theory of functioning, both positive reinforcers (e.g., a feeling of euphoria following exercise or muscle growth from exercise) and negative reinforcers (e.g. an end to unpleasant feelings through exercise or avoidance of the presumed negative effect of missed exercise) may lie behind the development and maintenance of exercise addiction which, according to the fundamental principles of learning theory, may contribute to the establishment of compulsive and addictive exercise that may be viewed as maladaptive.
One of my research colleagues, Dr. Attila Szabo stresses the role of cognitive appraisal mechanisms in the development of the vicious cycle that leads to excessive exercise. The process starts when the habitual exerciser uses exercise as a means of coping with stress, and the affected individual learns to depend on exercise at times of stress. The addicted exerciser is then trapped in a vicious cycle of needing increased amounts of exercise to deal with the consistently increasing life stress, part of which is caused by exercise itself.
It also appears that the issue of self-assessment represents a further significant factor among the psychological factors in the sense that during exercise, the physical strength experienced through exercise in a person dissatisfied with his or her body or body image contributes to the formation of a more positive self-image and self-assessment. It has also been shown that exercise activities (such as weightlifting) have a positive effect on body image and self-esteem both in men and in women. Perfectionism, obsessive-compulsive functioning, and heightened anxiety have also been claimed to be determining factors in exercise addiction.
The public promotion of healthy and appropriate exercise patterns may reduce the incidence of exercise addiction. It is important in public health programs and campaigns to (i) stress the healthy nature of regular exercise and (ii) communicate the message that exercise when taken to excess can be potentially harmful. It is important to raise awareness of potential harm within the population of regular exercisers. Some psychologists claim that individuals with exercise addiction have a poor understanding of the negative health consequences of excessive exercising, of the mechanism of exercise adaptation, and the need for rest between exercise sessions. The use of education may be an effective step in the prevention and treatment of exercise addiction.
As with other addictive disorders, the environment of regular exercisers also plays a significant role in recognising this condition early. In more severe cases psychotherapeutic interventions may be needed. When treating exercise addiction, abstinence from exercise may not be a required and/or realistic goal, because exercise has many benefits for health and no one would advocate doing no exercise. Therefore, the typical treatment goal would more likely be be to return to moderate and controlled exercise. In some cases, a different form of exercise may be recommended.
CASE STUDY
Joanna is a 25-year old student, well-educated female, from a stable family background, who realized that she had a problem surrounding exercise, and more specifically the martial art Jiu-Jitsu. Here, Joanna’s behavior is described in terms of the main components of addiction:
- Salience: Jiu-Jitsu is the most important activity in Joanna’s life. Even when not actually engaged in the activity, she is thinking about the next training session or competition. She estimates that she spends approximately six hours a day (and sometimes much more) involved in training (e.g., weight training, jogging, general exercise, etc.).
- Tolerance: Joanna started Jiu-Jitsu at an evening class once a week during her teenage years and built up slowly over a period of about five years. She now exercises every single day, and the lengths of the sessions have become longer and longer (suggesting tolerance).
- Withdrawal: Joanna claims she becomes highly agitated and irritable if she is unable to exercise. She claims she also gets headaches and feels nauseous if she goes for more than a day without training or has to miss a scheduled session.
- Mood modification: Joanna experiences mood changes in a number of ways. She feels very high and ‘buzzed up’ if she has done well in a Jiu-Jitsu competition (especially so if she wins). She also feels high if she has trained hard and for a long time.
- Conflict: Joanna’s relationship with her long-term partner ended as a result of her exercise. She claimed she never spent much time with him and was not even bothered about their break-up. Her university work suffered because of the lack of time and concentration.
- Loss of control: Joanna claims she cannot stop herself engaging in exercise when she “gets the urge”. Once she has started, she has to do a minimum of a few hours of exercise.
- Relapse: Joanna has continually tried to stop and/or cut down but claims she cannot. She becomes highly anxious if she is unable to engage in exercise and then has to go out and train to make herself feel better. She is well aware that exercise has taken over her life but feels powerless to stop it.
- Negative consequences: Joanna spends money beyond her means to maintain her exercising habit (e.g., on entrance fees for weight training, swimming, entrance fees enter Jiu-Jitsu tournaments across the country, etc.). She has resorted to socially unacceptable means (e.g., stealing) in order to get money to fund herself
In short, exercise is the most important thing in Joana’s life, and the number of hours engaged in physical activity per week has increased substantially over a five-year period. She displays withdrawal symptoms when she does not exercise, and experiences euphoric experiences related to various aspects of her exercising (e.g., training hard, winning competitions, etc.). She experiences conflict over exercise in many areas of her life and acknowledges she has a problem. Furthermore, she has lost friends, her relationship has broken down, her academic work has suffered, and she has considerable debt.
Note: An expanded version of this article was first published by Rehabs.com
Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Further reading
Allegre, B., Souville, M., Therme, P., & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory, 14, 631-646.
Allegre, B., Therme, P., & Griffiths, M. D. (2007). Individual factors and the context of physical activity in exercise dependence: A prospective study of ‘ultra-marathoners’. International Journal of Mental Health and Addiction, 5, 233-243.
Berczik, K., Szabó, A., Griffiths, M. D., Kurimay, T., Kun, B., Urbán, R., & Demetrovics, Z. (2012). Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Substance Use and Misuse, 47, 403-417.
Downs, D. S., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychomaetric examination of the Exercise Dependence Scale-Revised. Measurement in Phisical Education and Exercise Science, 8, 183-201.
Griffiths, M. (1997). Exercise addiction: A case study. Addiction Research, 5, 161-168.
Griffiths, M. D., Szabo, A., & Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39, e30-31.
Hausenblas H. A., & Downs, S. D. (2002a) Exercise dependence: a systematic review. Psychology of Sport Exercise, 3, 89-123.
Hausenblas, H. A., & Downs, S. D. (2002). How much is too much? The development and validation of the exercise dependence scale. Psychology and Health, 17, 387-404.
Mónok, K., Berczik, K., Urbán, R., Szabó, A., Griffiths, M.D., Farkas, J., Magi, A., Eisinger, A., Kurimay, T., Kökönyei, G., Kun, B., Paksi, B. & Demetrovics, Z. (2012). Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study in Hungary. Psychology of Sport and Exercise, 13, 739-746.
Sussman, S., Lisha, N., & Griffiths, M. D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Szabo, A. (2000). Physical activity as a source of psychological dysfunction. In S. J. Biddle, K. R. Fox & S. H. Boutcher (Eds.), Physical Activity and Psychological Well-Being (pp. 130-153). London: Routledge.
Szabo, A., & Griffiths, M. D. (2007). Exercise addiction in British sport science students. International Journal of Mental Health and Addiction, 5, 25-28.
Terry, A., Szabo, A., & Griffiths, M. (2004). The exercise addiction inventory: a new brief screening tool. Addiction Research and Theory, 12, 489-499.
