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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).

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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.

Go sober this October: How to lower your alcohol intake this month

Last week I was interviewed by the Daily Telegraph about this year’s  ‘Go Sober For October‘ (“Octsober”) campaign. In addition to wanting some tips on how to cut down alcohol intake (see below), they wanted to know why people are so reliant on alcohol to relieve stress, socialise and escape. On a very simple level, alcohol is a pharmacological depressant that enhances disinhibition (i.e., a disregard for social conventions) and which is both physiologically and psychologically rewarding. Like most addictive behaviours it is a mood modifier that can either get individuals high, excited, buzzed up and aroused or (somewhat paradoxically) do the exact opposite and help them escape, numb, relax and de-stress. The fact that it’s socially condoned and widely available make it a perfect substance for individuals to use and misuse.

go-sober

The remainder of today’s blog provides some tips on the simplest ways to cut down on alcohol intake. They are not aimed at problem drinkers as they require extra external support and interventions from family, friends, doctors and/or therapists. The tips below come from a variety of sources (listed in ‘Further reading’). I don’t claim to be an expert on alcohol addiction (although I have published more than a few papers on alcohol problems over the years – again, see some of these in ‘Further reading’ below) but most of these tips are practical and common sense:

Don’t go it alone: If you really want to cut down your alcohol intake, try do it with your friends and family together. Doing it with others rather than on your own means you will have others around you going through the same thing as yourself as well as having a ready made support group.

Don’t buy rounds of drinks in pubs and clubs: If you’ve ever been out on a pub crawl with friends, you will know that you tend to drink at the pace of the quickest drinker in the group (and this may be at a quicker rate than you would ideally prefer). If you do want to drink in rounds, then try opting out every other round and/or try to drink with a smaller group of friends (as larger groups typically lead to more alcohol being drunk over the course of an evening).

Spread out your drinking and drink more slowly: Sounds obvious but it’s true. (As I noted above, in places where alcohol is very expensive this becomes a natural option). A related option is to have one alcoholic drink followed by one non-alcoholic drink throughout the evening.

Don’t buy pints, doubles or large glass drinks: When you do drink in pubs and clubs, order smaller measures (wine in a small glass rather than a large one, halves instead of pints, a bottle of lager rather than a pint of lager). All of these smaller options mean a reduced ‘alcohol by volume’ ratio (i.e., less alcohol actually consumed). If you are the kind of person who says to yourself ‘I never have more than two glasses of wine a night’, then changing to a smaller glass will have an immediate and appreciable effect in lowering overall alcohol intake.

Where possible choose non–alcoholic drinks: When you eat out or dine at home, have a soft drink, juice or water rather than wine or beer with your meal.

Dilute alcoholic drinks: If the option of a non-alcoholic drink isn’t always possible or simple doesn’t appeal, then dilute your drinks. Have a lager shandy or a white wine spritzer.

Have ‘alcohol-free’ days: If you drink every day, start by trying to drink alcohol every other day. If you drink alcohol a few times a week, try to drink just once a week. Just cutting down on your normal weekly pattern will help you to realise that you can go without alcohol.

Avoid cocktails: Cocktails often contains a lot more alcohol than people think.

Drink alcohol free beers and lagers: If you love the taste of lager or beer, there are alcohol free options. There are also an increasing number of fake cocktails (‘mocktails’).

Reward yourself for not drinking alcohol: Many people drink as a way to alleviate the stresses and strains of every day life (or to do the exact opposite – to celebrate the fact that you’ve done something well or because it is a special occasion). The money not spent on alcohol could go towards giving yourself another kind of treat or reward (a massage, the new CD you wanted, watching a film at the cinema, etc.).

Tell everyone in your social circle you’re cutting down alcohol intake: By telling everyone you know including family, friends and work colleagues, you will be more committed to not drinking alcohol than if you told no-one.

Avoid temptation: One of the key factors in any potentially addictive activity is knowing what the ‘triggers’ are (e.g., walking past a pub, watching television, having an argument with your loved one, etc.). Knowing what the triggers are can be a strategy for avoiding temptation (e.g., changing the routes on your way back home to avoid walking past your favourite pub, doing something else instead of watching television, etc.).

Get a new hobby: Changing one aspect of your routine life can also help change other aspects. Sometimes, changing one aspect of your life (such as introducing daily exercise) goes hand-in-hand with other areas of your life (drinking less alcohol, eating more healthily).

Think of the benefits of not drinking alcohol: Not drinking alcohol can bring lots of positives. In six months without alcohol I’ve lost about 6.35kg in weight because alcohol is high in calories (and that’s without exercise!). Other benefits include more money for other things, better quality sleep, less stress (because alcohol is a depressant), and better health.

Use alcohol tracking tools: Many apps are now available to help you keep track of your alcohol intake. For instance, the MyDrinkaware tool allows you to see how alcohol is affecting you on a number of different dimensions including your health (how many units you are consuming over time), weight (how many calories you are consuming over time), and finances (how much money you are spending on alcohol over time).

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

Further reading

Drinkaware (2015). Tips for cutting down when out. Located at: https://www.drinkaware.co.uk/make-a-change/how-to-cut-down/cutting-down-when-out-and-about/tips-for-cutting-down-when-out

Drinkaware (2015). Track your drinking. Located at: https://www.drinkaware.co.uk/unitcalculator#unitcalculator

Griffiths, M.D. (2014). I drink, therefore I am: The UK’s alcohol dependence. Intervene, April, 20-23.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: Findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Glynn, S. (2012). Living close to a bar increases chance of risky drinking. Medical News Today, November 7. Located at: http://www.medicalnewstoday.com/articles/252462.php

NHS Choices (2015). Tips on cutting down [alcohol]. Located at: http://www.nhs.uk/Livewell/alcohol/Pages/Tipsoncuttingdown.aspx

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Confession session: The psychology of apology

(Please note: The following blog is an extended version of an article that was first published earlier this year in the Nottingham Post).

Back in March 2016, Nottingham Labour Councillor Alan Rhodes made a public apology after the former social worker Andris Logins was jailed for 20 years for rape and abuse of children at a Nottinghamshire care home. Mr Rhodes said: “It was our role to keep children safe and we clearly didn’t” and that “we failed in our duty of care”. Although most of us apologise for all sorts of things each day, it’s becoming increasingly common for a ‘non-celebrities’ to say sorry in a public way – particularly for historical events that the person giving the apology had no part in.

There are three main ways of saying sorry. The first is the apology with no excuse, when we don’t try to justify what we’ve done. We simply take full responsibility and promise it will never happen again. Secondly, there’s the excuse apology when we say we’re sorry but also add it wasn’t our fault. For instance, we might blame someone else, an accident, human error, or a lapse of judgement. With the third type of apology, we don’t feel we’ve done wrong, but offer some sort of justification. If we’ve wronged someone, we might say they deserved it. We might even feel what we’ve done is so trivial it’s not even worth bothering about. Dr. Aaron Lazare, author of the 2005 book On Apology, says that an apology is one of the most profound interactions that two human beings can have between one another

But why do we apologise? Psychologist Dr. Guy Winch views apologies as linguistic tools that help us acknowledge violations of social expectations and norms. He also says that apologies help us take direct responsibility for the impact of our actions on other individuals and provide a way of asking for forgiveness. Consequently, we are able to repair our relationships with those individuals, restore our own social standing, and help ease guilt and/or shame. Confessing and saying sorry is a simple way to get rid of all those negative feelings. The guilt created by transgressions, such as lying on a CV, or cheating in an exam, can eat away at some people for years.

There also appear to be gender differences. Research studies have tended to find that women appear to say sorry far more than men, because men feel they’re ‘one down’ to someone if they offer an apology. In contrast, women will say sorry for things they haven’t done because they prefer to smooth things over quickly and keep relationships going. However, the differences may be more nuanced. One study found no differences between men and women in the number of the proportion of offenses that prompted apologies but men apologized less frequently than women because they had a higher threshold for what constitutes offensive behaviour. Another study found that men apologized more frequently to women than they did to other men.

We also appear to have developed a ‘confessional culture’ over recent years in which celebrities and politicians are keener than ever to publicly admit to their private indiscretions. It could be that we’re more forgiving of public figures and that because we know more about the pressures of fame, we empathise with them. Another reason might be we no longer care because we don’t think what someone does in the private life affects their job. One thing we do expect from public figures is for their apologies to be sincere.

Arguably one of the most high profile examples was former US president Bill Clinton and his sexual relationship with Monica Lewinsky. Although Clinton continually denied for seven months any such relationship, when he eventually said sorry in August 1998, it was seen as sincere and many people sympathised with him. By apologising sincerely, or appearing to, public figures demonstrate they’re human, with weaknesses just like the rest of us.

bill-clinton-monica-lewinsky

These days, celebrities are quick to admit to what they’ve done. Lots of actors, comedians, singers and sports people have confessed to their addictions to drugs, alcohol and gambling before checking into high profile clinics like The Priory. For some, it’s no doubt a cynical move to help their public image. By apologising promptly, they’re seen as being brave, and any bad publicity will die down more quickly. Those who offer belated, grudging apologies see their image suffer.

Apologies can also help those who receive them. Police forces up and down the country have piloted schemes where criminals are confronted by their victims and offered a chance to apologies (known as ‘restorative justice’). Many victims say the one thing they’d really appreciate is an apology, and they’re often grateful to receive on. As the saying goes, “sorry seems to be the hardest word” but it has the potential to mean so much to so many.

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

Further reading

Bachman, G. F., & Guerrero, L. K. (2006). Forgiveness, apology, and communicative responses to hurtful events. Communication Reports, 19(1), 45-56.

Griffiths, M.D. (2000). Saying sorry can make you feel so much better. The Sunday Post, January 23, p. 30-31.

Griffiths, M.D. (2016). Sorry may be the hardest word but more people than ever are saying it. Nottingham Post, April 11, p.14.

Fehr, R., & Gelfand, M.J. (2010). When apologies work: How matching apology components to victims’ self-construals facilitates forgiveness. Organizational Behavior and Human Decision Processes, 113(1), 37-50.

Frantz, C.M., & Bennigson, C. (2005). Better late than early: The influence of timing on apology effectiveness. Journal of Experimental Social Psychology, 41(2), 201-207.

Lazare, A. (2005). On Apology. Oxford: Oxford University Press.

Scher, S. J., & Darley, J. M. (1997). How effective are the things people say to apologize? Effects of the realization of the apology speech act. Journal of Psycholinguistic Research, 26(1), 127-140.

Struthers, C. W., Eaton, J., Santelli, A. G., Uchiyama, M., & Shirvani, N. (2008). The effects of attributions of intent and apology on forgiveness: When saying sorry may not help the story. Journal of Experimental Social Psychology, 44(4), 983-992.

Takaku, S. (2001). The effects of apology and perspective taking on interpersonal forgiveness: A dissonance-attribution model of interpersonal forgiveness. Journal of Social Psychology, 141(4), 494-508.

Takaku, S., Weiner, B., & Ohbuchi, K.I. (2001). A cross-cultural examination of the effects of apology and perspective taking on forgiveness. Journal of Language and Social Psychology, 20(1-2), 144-166.

Winch, G. (2013). Emotional First Aid: Healing Rejection, Guilt, Failure, and Other Everyday Hurts. London: Penguin.

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

In dependence days: A brief overview of behavioural addictions

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

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

  • Salience – This occurs when the activity becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialized behaviour). For instance, even if the person is not actually engaged in the activity they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with the activity).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of engaging in the activity and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’).
  • Tolerance – This is the process whereby increasing amounts of the activity are required to achieve the former mood modifying effects. This basically means that for someone engaged in the activity, they gradually build up the amount of the time they spend engaging in the activity every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to engage in the activity.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (e.g., work, social life, hobbies and interests) or from within the individual (e.g., intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time engaging in the activity.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive engagement in the activity to recur, and for even the most extreme patterns typical of the height of excessive engagement in the activity to be quickly restored after periods of control.

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

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

Booze news: What are the simplest ways to reduce your alcohol intake?

Last week I did an interview with the Daily Mail about how to cut down alcohol intake. The hook of the story was from a 2012 Finnish study published in the journal Addiction. The longitudinal study examined whether how close a person lives to a pub or bar and whether it had any effect on risky drinking behaviour (‘Living in proximity of a bar and risky alcohol behaviours: a longitudinal study’). The study was briefly summarized in Medical News Today:

“People who live close to an on-site alcohol outlet, such as a bar, are more likely to engage in risky alcohol behavior, while people who live further away have a lower chance of dangerous drinking. The researchers analyzed data consisting of the locations of licensed on-site alcohol outlets between 2000 and 2008, which was taken from the alcohol licence register, maintained by Valvira (National Supervisory Authority for Welfare and Health). They then reviewed data on alcohol consumption from surveys taken from the Finnish Institute of Occupational Health’s (FIOH) Public Sector study from 2000 to 2009. More than 78,000 people filled out at least one survey and over 55,000 took at least two surveys. The team found that people who lived less than a kilometer away from a bar or other on-site alcohol outlet had a 13% higher chance of heavy alcohol use compared to those who lived more than a kilometer away. When a people changed the location of their house between the two study surveys, the likelihood changed. [More specifically] (i) a shorter distance raised the likelihood of risky drinking by 17%, [and] (ii) a longer distance decreased the likelihood by 17%The authors concluded that people have a higher chance of consuming alcohol if they live close to an on-site alcohol outlet”.

This is an example of the ‘availability hypothesis’ that is well known in most areas of addictive behaviour. In my own field of gambling studies, there is a general rule of thumb that where the opportunities and access to gambling are increased, more people engage in gambling (although this is not necessarily proportional to the level of problem gambling). The relationship between accessibility and engagement in addictive behaviour is complex as many other factors come into play. However, the Finnish study on risky drinking and proximity to alcohol outlets provides empirical support for the availability hypothesis.

There are also likely to be cultural differences. A lot of my consultancy work is for Scandinavian companies and I have been fortunate to visit Finland, Norway, Sweden and Denmark many times. One thing that is very noticeable in these countries is that alcohol is highly taxed and it is very expensive to drink alcohol in bars. On one of my first visits to Norway in the mid-1990s, I insisted on buying a round of drinks for the six people I was with (even though they were pleading with me not to). When I was charged 350 Krone (about £35) I began to understand why. My experience is that buying rounds of drinks appears to be very rare and I noticed that many people would make their pint of lager last hours in the bar.

Moving to countries like Norway as a way of cutting down on alcohol intake is a drastic option as there are many other simple ways that we can cut down on drinking alcohol. Unfortunately, as a result of a chronic medical condition I was told to stop drinking alcohol last September (2014). In the last six months I have drank only 8 units of alcohol (and 6 of those units were on New Year’s Eve). My own reduction in alcohol intake was forced upon me. I can obviously choose to ignore my doctor’s advice but I decided not to. Any woman has to make a similar decision about whether they consume alcohol and/or nicotine during pregnancy.

The remainder of today’s blog provides some tips on the simplest ways to cut down on alcohol intake. They are not aimed at problem drinkers as they require extra external support and interventions from family, friends, doctors and/or therapists. The tips below come from a variety of sources (listed in ‘Further reading’). I don’t claim to be an expert on alcohol addiction (although I have published more than a few papers on alcohol problems over the years – again, see some of these in ‘Further reading’ below) but most of these tips are practical and common sense:

  • Don’t go it alone: If you really want to cut down your alcohol intake, try do it with your friends and family together. Doing it with others rather than on your own means you will have others around you going through the same thing as yourself as well as having a ready made support group.
  • Don’t buy rounds of drinks in pubs and clubs: If you’ve ever been out on a pub crawl with friends, you will know that you tend to drink at the pace of the quickest drinker in the group (and this may be at a quicker rate than you would ideally prefer). If you do want to drink in rounds, then try opting out every other round and/or try to drink with a smaller group of friends (as larger groups typically lead to more alcohol being drunk over the course of an evening).
  • Spread out your drinking and drink more slowly: Sounds obvious but it’s true. (As I noted above, in places where alcohol is very expensive this becomes a natural option). A related option is to have one alcoholic drink followed by one non-alcoholic drink throughout the evening.
  • Don’t buy pints, doubles or large glass drinks: When you do drink in pubs and clubs, order smaller measures (wine in a small glass rather than a large one, halves instead of pints, a bottle of lager rather than a pint of lager). All of these smaller options mean a reduced ‘alcohol by volume’ ratio (i.e., less alcohol actually consumed). If you are the kind of person who says to yourself ‘I never have more than two glasses of wine a night’, then changing to a smaller glass will have an immediate and appreciable effect in lowering overall alcohol intake.
  • Where possible choose nonalcoholic drinks: When you eat out or dine at home, have a soft drink, juice or water rather than wine or beer with your meal.
  • Dilute alcoholic drinks: If the option of a non-alcoholic drink isn’t always possible or simple doesn’t appeal, then dilute your drinks. Have a lager shandy or a white wine spritzer.
  • Have ‘alcohol-free’ days: If you drink every day, start by trying to drink alcohol every other day. If you drink alcohol a few times a week, try to drink just once a week. Just cutting down on your normal weekly pattern will help you to realise that you can go without alcohol.
  • Avoid cocktails: Cocktails often contains a lot more alcohol than people think.
  • Drink alcohol free beers and lagers: If you love the taste of lager or beer, there are alcohol free options. There are also an increasing number of fake cocktails (‘mocktails’).
  • Reward yourself for not drinking alcohol: Many people drink as a way to alleviate the stresses and strains of every day life (or to do the exact opposite – to celebrate the fact that you’ve done something well or because it is a special occasion). The money not spent on alcohol could go towards giving yourself another kind of treat or reward (a massage, the new CD you wanted, watching a film at the cinema, etc.).
  • Tell everyone in your social circle you’re cutting down alcohol intake: By telling everyone you know including family, friends and work colleagues, you will be more committed to not drinking alcohol than if you told no-one.
  • Avoid temptation: One of the key factors in any potentially addictive activity is knowing what the ‘triggers’ are (e.g., walking past a pub, watching television, having an argument with your loved one, etc.). Knowing what the triggers are can be a strategy for avoiding temptation (e.g., changing the routes on your way back home to avoid walking past your favourite pub, doing something else instead of watching television, etc.).
  • Get a new hobby: Changing one aspect of your routine life can also help change other aspects. Sometimes, changing one aspect of your life (such as introducing daily exercise) goes hand-in-hand with other areas of your life (drinking less alcohol, eating more healthily).
  • Think of the benefits of not drinking alcohol: Not drinking alcohol can bring lots of positives. In six months without alcohol I’ve lost about 6.35kg in weight because alcohol is high in calories (and that’s without exercise!). Other benefits include more money for other things, better quality sleep, less stress (because alcohol is a depressant), and better health.
  • Use alcohol tracking tools: Many apps are now available to help you keep track of your alcohol intake. For instance, the MyDrinkaware tool allows you to see how alcohol is affecting you on a number of different dimensions including your health (how many units you are consuming over time), weight (how many calories you are consuming over time), and finances (how much money you are spending on alcohol over time).

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

Further reading

Drinkaware (2015). Tips for cutting down when out. Located at: https://www.drinkaware.co.uk/make-a-change/how-to-cut-down/cutting-down-when-out-and-about/tips-for-cutting-down-when-out

Drinkaware (2015). Track your drinking. Located at: https://www.drinkaware.co.uk/unitcalculator#unitcalculator

Griffiths, M.D. (2014). I drink, therefore I am: The UK’s alcohol dependence. Intervene, April, 20-23.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Halonen, J. I., Kivimäki, M., Virtanen, M., Pentti, J., Subramanian, S. V., Kawachi, I., & Vahtera, J. (2013). Living in proximity of a bar and risky alcohol behaviours: a longitudinal study. Addiction, 108(2), 320-328.

Glynn, S. (2012). Living close to a bar increases chance of risky drinking. Medical News Today, November 7. Located at: http://www.medicalnewstoday.com/articles/252462.php

NHS Choices (2015). Tips on cutting down [alcohol]. Located at: http://www.nhs.uk/Livewell/alcohol/Pages/Tipsoncuttingdown.aspx

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

I love view: Can Google Glass be addictive?

Last week, The Guardian (and news media all over the world) reported the story of a man being treated for internet addiction disorder brought on by his excessive use of Google Glass. According to The Guardian’s report:

“The man had been using the technology for around 18 hours a day – removing it only to sleep and wash – and complained of feeling irritable and argumentative without the device. In the two months since he bought the device, he had also begun experiencing his dreams as if viewed through the device’s small grey window…[The patient] had checked into the Sarp [Substance Addiction Recovery Program] in September 2013 for alcoholism treatment. The facility requires patients to steer clear of addictive behaviours for 35 days – no alcohol, drugs, or cigarettes – but it also takes away all electronic devices. Doctors noticed the patient repeatedly tapped his right temple with his index finger. He said the movement was an involuntary mimic of the motion regularly used to switch on the heads-up display on his Google Glass”.

The story was based on a case study that has just been published in the journal Addictive Behaviors by Dr. Kathryn Yung and her colleagues from the Department of Mental Health, Naval Medical Center in San Diego (United States). The authors claim that the paper (i) reported the first ever case of internet addiction disorder involving the problematic use of Google Glass, (ii) showed that excessive and problematic uses of Google Glass can be associated with involuntary movements to the temple area and short-term memory problems, and (iii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass. For those reading this who have not yet come across what Google Glass is, the authors provided a brief description: 

Google Glass™ was named as one of the best inventions of the year by Time Magazine in 2012. The device is a wearable mobile computing device with Bluetooth connectivity to internet-ready devices. Google Glass™ has an optical head-mounted display, resembling eyeglasses; it displays information in a Smartphone-like, but hands-free format that is controlled via voice commands and touch”.

The man that came in for treatment was a 31-year old enlisted service member who had served seven months in Afghanistan. Although he did not suffer any kind of post-traumatic stress disorder (PTSD) he was reported by the authors as having a mood disorder, most consistent with a substance-induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia, obsessive–compulsive disorder, and severe alcohol and tobacco use disorders”. His referral to the substance use program was because he had resumed problematic alcohol drinking following a previous eight-week intensive outpatient treatment. It was only after re-entering the program that staff noticed other behaviours that were nothing to do with his alcohol problem. More specifically, they reported that:

“The patient had been wearing the Google Glass™ device each day for up to 18 h for two months prior to admission, removing the device during sleep and bathing. He was given permission by his superiors to use the device at work, as the device allowed him to function at a high level by accessing detailed and complicated information quickly. The patient shared that the Google Glass™ increased his confidence with social situations, as the device frequently became an initial topic of discussion. All electronic devices and mobile computing devices are customarily removed from patients during substance rehabilitation treatment. The patient noted significant frustration and irritability related to not being able to use the device during treatment. He stated, ‘The withdrawal from this is much worse than the withdrawal I went through from alcohol’, He noted that when he dreamed during his residential treatment, he envisioned the dream through the device. He would experience the dream through a small gray window, which was consistent with what he saw when wearing the device while awake. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. When asked questions by the examiner, the patient was noted on exam to reach his right hand up to his temple area and tap it with his forefinger. He explained that this felt almost involuntary, in that it was the familiar motion he would make in order to turn on the device in order to access information and answer questions. He found that he almost ‘craved’ using the device, especially when trying to recall information”.

Even though my primary area of research interest in behavioural addictions, the thing that caught my attention in the description above was the observation that his dreams were experienced in the way he viewed things through Google Glass while he was awake. On first reading this I thought this sounding very much like some research I have been doing with my colleague Angelica Ortiz de Gortari on Game Transfer Phenomena (GTP) in which gamers transfer aspects of their game playing into real life situations. Our work is an extension of the so-called Tetris Effect where Tetris players see falling blocks before their eyes even when they are not playing the game. It appears the authors of this case study has also made the same connection as they reported:

The patient’s experiences of viewing his dreams through the device appear to be best explained solely by his heavy use of the device and may be consistent with what is referred to as the ‘Tetris Effect’. When individuals play the game Tetris for long periods of time, they report seeing invasive imagery of the game in their sleep (Stickgold, Malia, Maguire, Roddenberry, & O’Connor, 2000). Interestingly, Stickgold et al. noted that patients with amnesia due to traumatic brain injury, who had trouble with short-term memory recall, reported invasive imagery of the game during sleep even though they did not recall playing the game (Stickgold et al., 2000). Technology-assisted learning devices and video gaming appear to be powerful methods to aid in the acquisition of new information. Further studies in the field of traumatic brain injury utilizing gaming and technology-assisted learning are needed”.

At the end of the 35-day inpatient stay, the outcome was reported as being good. The patient reported he felt less irritable, and he was making far fewer compulsive movements to his temple. However, no further follow-up was reported by Yung and her colleagues. There are, of course, wider questions about whether addiction to the internet even exists although the article in The Guardian did provide a link to a comprehensive and systematic review of internet addiction that I co-authored with Dr. Kuss and others in the journal Current Pharmaceutical Design. As regular readers of my blog will be aware, I believe that there is a fundamental difference between addictions on the internet and addictions to the internet. The vast majority of people appear to have addictions on the internet (such as gambling addiction, gaming addiction, sex addiction, shopping addiction, etc.) where the internet facilitates other addictive behaviours. However, there is growing evidence of internet-only addictive behaviour (with social networking addiction being the most common).

In relation to this case study, there have been some that have said that the study doesn’t have face validity because the battery life of Google Glass is so small that it is impossible to spend up to 18 hours a day wearing it. (For instance, check out an interesting article written by Taylor Hatmaker published by the Daily Dot). I ought to add that one of the study’s co-authors, Dr. Andrew Doan did say to various news outlets that:

“A wearable device is constantly there – so the neurological reward associated with using it is constantly accessible. There’s nothing inherently bad about Google Glass. It’s just that there is very little time between these rushes. So for an individual who’s looking to escape, for an individual who has underlying mental dysregulation, for people with a predisposition for addiction, technology provides a very convenient way to access these rushes. And the danger with wearable technology is that you’re allowed to be almost constantly in the closet, while appearing like you’re present in the moment”.

Based on the two-page paper that was published, I don’t think there was enough evidence presented to say whether the man in question was addicted to the internet via Google Glass. There were certainly elements associated with addiction but that doesn’t mean somebody is genuinely addicted. Furthermore, most addictive behaviours have to have been present for at least six months before being diagnosed as a genuine addiction. In this case, the man had only been using Google Glass for two months before entering the treatment program.

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

Further reading

Ghorayshi, A. (2014). Google glass user treated for internet addiction caused by device. The Guardian, October 14. Located at: http://www.theguardian.com/science/2014/oct/14/google-glass-user-treated-addiction-withdrawal-symptoms

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

Hatmaker, T. (2014). There is no such thing as Google Glass addiction. The Daily Dot, October 15. Located at: https://www.dailydot.com/technology/google-glass-internet-addiction/

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the game: Hypnagogic images in normals and amnesics. Science, 290, 350–353.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2014.09.024.

I drink, therefore I am: A brief look at alcohol dependence in Great Britain

Alcohol dependence is often viewed as a cluster of behavioural, cognitive, and physiological phenomena that in most affected people includes a strong desire to consume alcohol, and have difficulties in controlling their drinking. According to a 2013 report by Alcoholics Anonymous, alcoholism kills more people in the UK than any other drug apart from nicotine. Based on Government statistics, they claim one adult in every 13 is alcohol-dependent (although this is much higher than data collected from the most methodologically robust studies – see below). The General Household Survey (GHS) and the General Lifestyle Survey (GLF) have been measuring drinking behaviour for over 30 years. In relation to alcohol use, the latest 2013 Office for National Statistics (ONS) report notes that:

“The Department of Health estimates that the harmful use of alcohol costs the National Health Service around £2.7bn a year and 7% of all hospital admissions are alcohol related. Drinking can lead to over 40 medical conditions, including cancer, stroke, hypertension, liver disease and heart disease. Reducing the harm caused by alcohol is therefore a priority for the Government and the devolved administrations. Excessive consumption of alcohol is a major preventable cause of premature mortality with alcohol-related deaths accounting for almost 1.5% of all deaths in England and Wales in 2011”.

The ONS notes that obtaining reliable data on drinking behaviour is difficult. Compared to national alcohol sales, surveys carried out by social scientists consistently record lower levels of how much alcohol they consume because participants may consciously and/or unconsciously be underestimating alcohol consumption (e.g., alcohol use in the home may be based on the number of glasses of wine drunk with the amount poured into the glass being much greater than a standard unit of alcohol). In the most recent 2013 report (based on data collected in 2011), participants were asked two questions about their alcohol consumption. These were (i) maximum amount of alcohol drunk on any one day in the previous seven days, and (ii) average weekly alcohol consumption. The survey also obtained three measures of maximum daily alcohol consumption.

  • Exceeding the recommended daily alcohol limit. This measure assessed the proportion of men and women exceeding the recommended units of alcohol on their heaviest drinking day (i.e. 4 units for men, 3 units for women).
  • Engaging in binge drinking (i.e., intoxication). This measure assessed the proportion of men and women who exceeded the number of daily units considered as intoxicating (i.e., 8 units for men, 6 units for women).
  • Engaging in heavy drinking. This measure assessed the proportion of men and women who drank more than three times the recommended daily units of alcohol (i.e., more than 12 units for men and more than 9 units for women).

The results indicated that:

  • Over half of all adults (59%) reported that they had consumed alcohol in the week prior to the survey.
  • Men (66%) were more likely than women (54%) to have had an alcoholic drink in the week before the survey
  • More men (16%) drank on at least five out of seven days than women (9%) in the week prior to the survey.
  • Almost one in ten men (9%) drank alcohol every day in the week prior to the survey compared to only one in twenty women (5%).
  • More men (34%) exceeded the daily recommended units of alcohol than women (28%).
  • More men (18%) were binge alcohol drinkers than women (12%)
  • More men (9%) were heavy drinkers than women (6%)
  • Heavy drinking was most prevalent in those aged 16 to 44 years
  • Drinking alcohol was also associated with smoking nicotine with smokers being more likely to be binge drinkers and heavy drinkers.

Another major report on alcohol use in England was recently published by the Lifestyle Statistics, Health and Social Care Information Centre (in 2013). Their analyses were mainly obtained from the Health and Social Care Information Centre (HSCIC), Hospital Episodes Statistics (HES), and prescribing data. They reported that:

  • 61% of men and 72% of women had either drunk no alcohol in the last week, or had drunk within the recommended levels on the day they drank the most alcohol.
  • 64% of men drank no more than 21 units weekly, and 63% of women drank no more than 14 units weekly.
  • 12% of school pupils had drunk alcohol in the last week. This continues a decline from 26% in 2001, and is at a similar level to 2010, when 13% of pupils reported drinking in the last week.
  • In 2011/12, there were 200,900 admissions to English hospitals where the primary diagnosis was attributable to alcohol consumption (a 1% increase on the previous year).
  • In 2011/12, there were an estimated 1,220,300 admissions to English hospitals related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (an increase of 4% on the previous year).
  • In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community (an increase of 6% on the previous year).

Arguably the most robust data on alcohol dependence in the UK comes from the 2009 Adult Psychiatric Morbidity Survey (APMS) carried out by the National Centre for Social Research and University of Leicester. Alcohol problems (including alcohol dependence) were measured using the AUDIT (Alcohol Use Disorders Identification Test) and the SADQ-C (Severity of Alcohol Dependence Questionnaire, community version). An AUDIT score of eight or more indicated hazardous drinking, and 16 or more indicated harmful drinking. SADQ-C scores of 4-19 indicated mild dependence; 20-34, moderate dependence; 35 or more, severe dependence.

Using the AUDIT, the prevalence of hazardous drinking was 24.2% (33.2% males, 15.7% females). A total of 3.8% of adults (5.8% males, 1.9% females) drank alcohol at harmful levels, i.e., around 1 in 25 adults. Among males, the highest prevalence of both hazardous and harmful drinking was in 25-34 year olds, whereas in females it was in 16 -24 year olds. Using the SADQ-C, the prevalence of alcohol dependence was 5.9% (8.7% males, 3.3% females), i.e., around 1 in 16 adults. For males, the highest levels of dependence were identified in those between the ages of 25-34 years (16.8%), whereas for females it was between the ages of 16-24 years (9.8%). Most of the recorded dependence levels were mild (5.4%), with relatively few adults showing symptoms of moderate or severe dependence (0.4% and 0.1% respectively). Compared to the previous APMS survey in 2000, the prevalence of alcohol dependence was lower for males in 2007, whereas it remained at a similar level for females.

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

Further reading

Lifestyle Statistics, Health and Social Care Information Centre (2013). Statistics on Alcohol: England, 2013. Located at: https://catalogue.ic.nhs.uk/publications/public-health/alcohol/alco-eng-2013/alc-eng-2013-rep.pdf

National Centre for Social Research/University of Leicester (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. London: NHS Information Centre

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

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.

Lack of ball control: Gambling addiction among football players

Earlier this month, ex-England footballer Kenny Sansom made the news after he was found homeless sleeping on a park bench following his self-admitted addictions to both gambling and alcohol. Gambling by footballers is nothing new of course. Back in 2006, the media lapped up the story that Wayne Rooney allegedly ran up gambling debts of £700,000 with the Goldchip betting company. At the time, the Government’s (then) Sports Minister, Richard Caborn, warned the England team footballers not to bet on World Cup matches endorsing the decision by football’s world governing body (FIFA) to outlaw players betting on the tournament. Today’s blog briefly looks at the issue of gambling addiction amongst footballers and whether it is an issue that clubs must take seriously.

So why do professional footballers gamble? Gambling and football have always been inextricably linked. Whether it is the football pools, a punt on who will win the FA Cup final, or a spread bet on the number of yellow cards to be handed out during the next World Cup, gamblers love betting on the outcome of football matches. But there are also good psychological reasons that encourage top players to gamble – particularly if looked at from the player’s perspective.

It is the night before a big match. Premiership players are confined to staying in a hotel. No sex. No alcohol. No junk food. Basically, no access to all the things they love. To pass time, footballers may watch television, play cards, or play a video game believing these are ‘healthier’ for them. The difficulty in detecting gambling addictions is likely to be one factor in its growth over other forms of addiction – especially as many players are more health-conscious and the testing for alcohol and drugs is now more rigorous. However, any of these ‘healthier’ activities when taken to excess can cause problems. England goalkeeper David James once claimed his loss of form was because of his round-the-clock video game playing. In short, the top players are very well paid and inevitably have lots of time on their hands. By their own admission, ex-Arsenal and England players like Paul Merson and Tony Adams lost millions of pounds gambling and regularly attended Gamblers Anonymous along with treatment for other addictions to alcohol and cocaine. Paul Merson claims to have lost £7 million to gambling and cocaine, and was still having severe gambling problems over a decade after his football career had ended.

It would also seem to be the case that there is a psychosocial subculture of gambling by footballers. The ex-England striker Kevin Phillips claimed that when he was part of Kevin Keegan’s England squad (as a Sunderland player in the 1990s), he was alienated by the other players for not taking part with the other players in the team’s pre-match gambling activities. Phillips’ ex-strike partner at Sunderland, Niall Quinn, knows only too well the inherent dangers of gambling. While playing for Arsenal he regularly lost his whole week’s wages at the bookmakers inside an hour of getting it. Whilst he was never truly out of control, he did have to re-mortgage his flat to pay off gambling debts. Quinn says he was lucky not to be paid the kind of wages players get today as he would have lost more. Ex-footballer (and now TV and radio football pundit) Steve Claridge claimed in his autobiography to have blown £1m on gambling, while the ex-Northern Ireland winger Keith Gillespie became addicted after placing bets for team-mates.

More recently, there have been a number of high profile cases of top footballers with gambling problems. These include the West Ham and Stoke winger Matthew Etherington and ex-England striker David Bentley who was reported to be placing up to 100 bets a day on everything from horses and greyhounds to online poker and bingo. Another high profile case to hit the headlines was Icelandic ex-Chelsea player Eidur Gudjohnsen who was alleged to be in £6 million in debt because of his gambling despite a £3 million-a-year wages at his current club Monaco. While he was at Manchester United, the Dutch striker Ruud Van Nistelrooy said that “obscene” wages were fuelling constant gambling by other players in the team.

I am often asked by the press to comment on why footballers gamble and whether they are more susceptible to gambling addiction. One player I was asked to comment on was ex-England striker Michael Owen (whose friend Stephen Smith – somewhat ironically – ran the company that Wayne Rooney ran up his debts with). It was clear that to me that Owen did not have a gambling problem and could easily afford to lose the amounts he was alleged to have lost. However, it could be argued that he and players like Wayne Rooney are role models for many teenagers. As a psychologist I have some concerns about the messages that high profile footballers send out about gambling to vulnerable individuals. Teenagers are less likely than adults to be able to make informed choices because they are young and impressionable. Footballers who gamble are unconsciously giving out the message to adolescents that gambling is something that goes hand-in-hand with being a top footballer.

Tony Adams alleged that every football club in England has a problem with gambling addiction. This was one of the primary reasons why set up his own charity (Sporting Chance) to help footballers with addiction problems. At present, this appears to be the main source of help for footballers who are problem gamblers, although Gamblers Anonymous also appears to be another popular outlet for help. Press reports from the mid-2000s indicated that up to 60 Premiership football players were being treated for gambling addiction. Adams alleged that some players – despite being on vast wages – even stole from their children’s savings to cover their losses. He said footballers that were gambling addicts “lose their self-respect and before you know where they are, they are nicking money out of their kids’ savings to have a bet. It is something about which clubs need to be aware. It is difficult to trace – but it can cause a lot of damage.” Peter Kay, the Chief Executive of the Sporting Chance clinic claims that footballer’s passion for football predisposes them to gambling problems. He said:

“If you have the kind of driven, obsessive character that it takes to become a professional footballer, with that tunnel-vision, then you are predisposed. I have not come across a football club where gambling does not play a part in the players’ lives. If a player is dropped from the team, this can often lead to depression and a craving for the buzz of football – sometimes found in gambling. It is acceptable to gamble. There have always been famous gamblers in football and for most it is enjoyable. But for around 10 per cent it is an addiction”.

Although the English Football Association has strict rules on gambling by footballers, these are not a deterrent to gamble and as outlined above, there are many reasons why footballers may gamble to excess compared to other less ‘healthy’ behaviours like excessive drinking or drug taking. It is a shame that addictions to drugs and alcohol tend to generate more sympathy among the general public as many people view gambling as a self-inflicted vice. But gambling to excess can be just as destructive because of the huge financial consequences. Therefore, time rich and money rich young footballers need to be educated about the potential downsides of excessive and/or high stakes gambling. Through the work of the Sporting Chance clinic, this is beginning to happen, but as footballers’ wages continue to increase, gambling is one activity that may place an increasing role in the lives of the players.

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

Further reading

Adams, T. and Ridley, I. (1999), Addicted. London: Harper Collins.

BBC Online News (2007). Etherington in gambling admission. February 24. Located at: http://news.bbc.co.uk/sport1/hi/football/teams/w/west_ham_utd/6392549.stm (Last accessed December 10, 2009).

Burt, J. (2003). Adams charity claims gambling addiction is rife. The Independent, January 16. Located at; http://www.independent.co.uk/sport/football/news-and-comment/adams-charity-claims-gambling-addiction-is-rife-601846.html (Last accessed December 10, 2009).

Chaytor, R. (2008), Paul Merson gambles away £300,000 home. Daily Mirror, November 1. Located at: http://www.mirror.co.uk/news/top-stories/2008/01/11/paul-merson-gambles-away-300-000-home-115875-20281696/ (Last accessed December 10, 2009).

Claridge, S. & Ridley, I. (2000). Tales From The Boot Camps. London: Orion.

Griffiths, M.D. (2006). All in the game. Inside Edge: The Gambling Magazine, July (Issue 28), p. 67.

Griffiths, M.D. (2010). Gambling addiction among footballers: causes and consequences. World Sports Law Report, 8(3), 14-16.

Menezes, J. de (2013). Former England star Kenny Sansom admits he’s ‘homeless, a drunk and sleeping on a park bench’. The Independent, August 1. Located at: http://www.independent.co.uk/sport/football/news-and-comment/former-england-star-kenny-sansom-admits-hes-homeless-a-drunk-and-sleeping-on-a-park-bench-8741512.html

Merson, P. (1996). Rock Bottom. London: Bloomsbury.

Peake, A. (2009). Eidur down £6M: Gambling has ace Gudjohnsen owing two banks. The Sun, December 3, p.25.

Winter, H. (2008). David Bentley had to fight gambling addiction. Daily Telegraph, April 10. Located at: http://www.telegraph.co.uk/sport/columnists/henrywinter/2296852/David-Bentley-had-to-fight-gambling-addiction.html (Last accessed December 10, 2009).