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.

Playing the field: Another look at Internet Gaming Disorder

Research into online addictions has grown considerably over the last two decades and much of it has concentrated on problematic gaming, particularly MMORPGs (Massively Multiplayer Online Role-Playing Games). In the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), Internet Gaming Disorder (IGD) (also commonly referred in the literature as problematic gaming and gaming addiction) was included in Section 3 (‘Emerging Measures and Models’) as a promising area that needed future research before being included in the main section of future editions of the DSM.

The DSM-5 proposed nine criteria for IGD (of which five or more need to be endorsed over the period of 12 months and result in clinically significant impairment to be diagnosed as experiencing IGD). More specifically the criteria include (1) preoccupation with games; (2) withdrawal symptoms when gaming is taken away; (3) the need to spend increasing amounts of time engaged in gaming, (4) unsuccessful attempts to control participation in gaming; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, gaming; (6) continued excessive use of games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of gaming; (8) use of gaming to escape or relieve a negative mood;  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in games.

There is no agreement on the prevalence of IGD as the vast majority of studies have surveyed non-representative self-selected samples using over 20 different screening instruments. A review of problematic gaming prevalence studies that I published with Orsi Király, Halley Pontes, and Zsolt Demetrovics (in the 2015 book Mental Health in the Digital Age: Grave Dangers, Great Promise) reported a large variation in the prevalence rates (from 0.2% up to 34%). However, we noted that there were many factors that could have accounted for the wide variation in prevalence rates including the type of gaming examined (i.e., some studies just examined online gaming, whereas others examined console gaming or a mixture of both), sample size, participants’ age range, participant type (i.e., some surveyed the general population while others assessed gamers only), and instruments used to assess gaming.

There have been a handful of studies that have reported the prevalence of IGD using nationally representative samples. The prevalence rates reported were 8.5% of American youth aged 8–18 years, 1.2% of German adolescents aged 13-18 years, 5.5% among Dutch adolescents aged 13-20, and 5.4% among Dutch adults, 4.3% of Hungarian adolescents aged 15-16 years, 1.4% of Norwegian gamers, and 1.6% of European youth from seven countries aged 14-17 years.

There are now over 20 different screening instruments including a number of new ones specifically incorporating the IGD criteria (including a number that I have co-developed with Halley Pontes). The multiplicity of problematic gaming screens remains a key challenge in the field and partially reflects the lack of consensus in terms of the assessment of the phenomenon. A comprehensive 2013 review that I published with Daniel King and others in Clinical Psychology Review examined the criteria of 18 problematic gaming screens. The 18 screens had been utilized in 63 quantitative studies (N=58,415 participants). The main weaknesses identified were (i) inconsistency of core addiction indicators across studies, (ii) a general lack of any temporal dimension, (iii) inconsistent cutoff scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or untested dimensionality. We also questioned the appropriateness of certain screens for certain settings, because those used in clinical practice may require a different emphasis than those used in epidemiological, experimental, or neurobiological research settings.

Research into IGD is needed from clinical, epidemiological, and neurobiological aspects of IGD. There has been an increasing number of neurobiological studies on IGD and a 2014 meta-analysis by Dr. Y. Meng and colleagues in Addiction Biology of 10 neuroimaging studies investigating the functional brain response to cognitive tasks from IGD using quantitative effect size signed differential mapping meta-analytic methods. found reliable clusters of abnormal activation in IGD within the regions comprising the bilateral medial frontal gyrus/cingulate gyrus, the left middle temporal gyrus and fusiform gyrus when compared to healthy controls. The same review also found that greater amounts of time spent per week playing was associated with hyper-activity in the left medial frontal gyrus and the right cingulate gyrus. Despite the useful findings reported, one of the major limitations of this meta-analysis was that 90% of the studies reviewed were conducted in Asian countries or regions, which might be problematic since prevalence rates of IGD in these populations are usually inflated compared to prevalence rates reported in Western countries. Furthermore, a systematic review of neuroimaging studies examining Internet addiction (IA) and IGD by Daria Kuss and myself in the journal Brain Sciences concluded that:

“These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains”

Over the last decade, a number of studies have investigated the association between IGD (and its derivatives) and various personality and comorbidity factors. Our recent review in the book Mental Health in the Digital Age: Grave Dangers, Great Promise summarized the research examining the relationship between personality traits and IGD. Empirical studies have shown IGD to be associated with (i) neuroticism, (ii) aggression and hostility, (iii) avoidant and schizoid tendencies, loneliness and introversion, (iv) social inhibition, (v) boredom inclination, (vi) sensation-seeking, (vii) diminished agreeableness, (viii) diminished self-control and narcissistic personality traits, (ix) low self-esteem, (x) state and trait anxiety, and (xi) low emotional intelligence. However, we noted that it was difficult to assess the aetiological significance of such associations because these personality factors are not unique to problematic gaming. Our review also reported that IGD had been associated with various comorbid disorders, including (i) attention deficit hyperactivity disorder, (ii) symptoms of generalized anxiety disorder, panic disorder, depression, and social phobia, and (iii) various psychosomatic symptoms.

According to a 2013 editorial in the journal Addiction, Nancy Petry and Charles O’Brien (2013), IGD will not be included as a separate mental disorder in future editions of the DSM until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) aetiology and associated biological features have been evaluated.

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

Please note: Additional input from Daria Kuss and Halley Pontes

Further reading

Gentile, D. (2009). Pathological video-game use among youth ages 8–18: A national study. Psychological Science, 20(5), 594-602. doi: 10.1111/j.1467-9280.2009.02340.x

Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.

Griffiths, M. D., King, D. L., & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4. doi: 10.2217/npy.13.82

Griffiths, M. D., Király, O., Pontes, H. M., & Demetrovics, Z. (2015). An overview of problematic gaming. In E. Aboujaoude & V. Starcevic (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp. 27-45). Oxford: Oxford University Press. doi: 10.1093/med/9780199380183.003.0002

Griffiths, M. D., & Pontes, H. M. (2014). Internet Addiction Disorder and Internet Gaming Disorder are not the same. Journal of Addiction Research & Therapy, 5(4), e124. doi: 10.4172/2155-6105.1000e124

Griffiths, M. D., & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3(1), 74-77. doi: 10.1556/JBA.2.2013.016

King, D. L., Haagsma, M. C., Delfabbro, P. H., Gradisar, M. S. & Griffiths, M. D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33(3), 331-342. doi: 10.1016/j.cpr.2013.01.002

Király, O., Griffiths, M. D., & Demetrovics, Z. (2015). Internet Gaming Disorder and the DSM-5: Conceptualization, debates, and controversies. Current Addiction Reports, 2(3), 254-262. doi: 10.1007/s40429-015-0066-7

Király, O., Griffiths, M. D., Urbán, R., Farkas, J., Kökönyei, G., Elekes, Z., Tamás, D., & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior, and Social Networking, 17(12), 749-754. doi: 10.1089/cyber.2014.0475

Király, O., Sleczka, P., Pontes, H. M., Urbán, R., Griffiths, M. D., & Demetrovics, Z. (2016). Validation of the ten-item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.11.005

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

Kuss, D. J., & Griffiths, M. D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2(3), 347-374. doi: 10.3390/brainsci2030347

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(25), 4026-4052. doi: 10.2174/13816128113199990617

Lemmens, J. S., Valkenburg, P. M., & Gentile, D.A. (2015). The Internet Gaming Disorder Scale. Psychological Assessment, 27(2), 567-582. doi: 10.1037/pas0000062

Meng, Y., Deng, W., Wang, H., Guo, W., & Li, T. (2014). The prefrontal dysfunction in individuals with Internet Gaming Disorder: A meta-analysis of functional magnetic resonance imaging studies. Addiction Biology, 20(4), 799-808. doi: 10.1111/adb.12154

Müller, K. W., Janikian, M., Dreier, M., Wölfling, K., Beutel, M. E., Tzavara, C., Richardson, C., & Tsitsika, A. (2015). Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. European Child and Adolescent Psychiatry, 24(5), 565-574. doi: 10.1007/s00787-014-0611-2

Petry, N. M., & O’Brien, C. P. (2013). Internet gaming disorder and the DSM-5. Addiction 108(7), 1186–1187. doi: 10.1111/add.12162

Pontes, H. M., & Griffiths, M. D. (2015). New concepts, old known issues: The DSM-5 and Internet Gaming Disorder and its assessment. In J. Bishop (Ed.), Psychological and Social Implications Surrounding Internet and Gaming Addiction (pp. 16-30). Hershey, PA: Information Science Reference. doi: 10.4018/978-1-4666-8595-6.ch002

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143. doi: 10.1016/j.chb.2014.12.006

Pontes, H. M., Szabo, A., & Griffiths, M. D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25. doi: 10.1016/j.abrep.2015.03.002

Pontes, H., Király, O. Demetrovics, Z., & Griffiths, M. D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H. M., Kuss, D. J., & Griffiths, M. D. (2015). Clinical psychology of Internet addiction: a review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23. doi: 10.2147/NAN.S60982

Rehbein, F., Kliem, S., Baier, D., Mößle, T., & Petry, N. M. (2015). Prevalence of Internet Gaming Disorder in German adolescents: Diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction, 110(5), 842–851. doi: 10.1111/add.12849

Thomas, N., & Martin, F. (2010). Video-arcade game, computer game and Internet activities of Australian students: Participation habits and prevalence of addiction. Australian Journal of Psychology. 62(2), 59-66. doi: 10.1080/00049530902748283

van Rooij, A. J., Schoenmakers, T. M., & van de Mheen, D. (2015). Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with ‘video game addiction’. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.10.018

Wittek, C. T., Finserås, T. R., Pallesen, S., Mentzoni, R. A., Hanss, D., Griffiths, M. D., & Molde, H. (2015). Prevalence and predictors of video game addiction: A study based on a national representative sample of gamers. International Journal of Mental Health and Addiction, 1-15. doi: 10.1007/s11469-015-9592-8

Young, K.S. (1999). Internet addiction: Symptoms, evaluation and treatment. Innovations in clinical practice: A source book, (Vol. 17; pp. 19-31). Sarasota, FL: Professional Resource Press.

Bought in the act: How prevalent is compulsive buying?

Although shopping is a necessity in modern life, it is also a leisure activity and a form of entertainment with a rewarding value for some people. However, as I have noted in a number of my previous blogs, when taken to the extreme, shopping (or buying) can be a harmful and destructive activity for a minority of individuals. The consequences of compulsive buying behaviour (CBB) are often underestimated.

For instance, CBB can result in (i) large debts, (ii) inability to meet payments, (iii) criticism from partners, friends and acquaintances, (iv) legal and financial consequences, (v) criminal legal problems, and (vi) guilt. Furthermore, individuals with CBB often describe an increasing level of urge or anxiety that can only be alleviated and lead to a sense of completion when a purchase is made. Research has demonstrated that compulsive buying is a frequent disorder in a small minority of shopping mall visitors and is associated with important and robust indicators of psychopathology such as psychiatric distress, borderline personality disorder, and substance abuse. Compared to non-compulsive buyers, compulsive buyers are over twice as likely to abuse substances, have any mood or anxiety disorder, and three times more likely to develop eating disorder than non-compulsive buyers. However, most of these findings are based on a small number of studies, all of which have sampling limitations.

Despite many studies highlighting the severe negative consequences that compulsive buying can lead to, the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) did not include compulsive buying disorder due to insufficient research in the field. Therefore, individuals with the condition are classified within the residual category of “Unspecified disruptive, impulse-control, and conduct disorders”. Diagnostic criteria elsewhere include (i) maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses; (ii) generation of marked distress by the buying preoccupations, impulses or behaviours, which are time consuming, significantly interfere with social or occupational functioning or result in financial problems; and (iii) lack of restriction of the excessive buying or shopping behaviour to periods of hypomania or mania.

The age of onset for CBB appears to be in the late teens or early twenties, although some studies have reported a later mean age of 30 years. There is also a lack of consensus relating to gender differences. Most clinical studies report that women are much more likely to become compulsive buyers than men, but not all surveys have found significant differences in buying tendencies between men and women. Cultural mechanisms have been proposed to recognize the fact that CBB mainly occurs among individuals living in developed countries. Elements reported as being necessary for the development of CBB include the presence of a market-based economy, the availability of a wide variety of goods, disposable income, and significant leisure time. For these reasons, most working in the area agree that CBB is unlikely to occur in poorly developed countries, except among the wealthy elite.

Given this background, Aniko Maraz, Zsolt Demetrovics and I recently carried out a meta-analytic review that was published in the journal Addiction using all the empirical data concerning the prevalence of compulsive buying in non-clinical populations. We attempted to estimate a pooled prevalence of compulsive buying behaviour (CBB) in different populations across the world where studies have been carried out. We also examined the effect of age, gender, geographical location of the study.

Our initial literature search identified 638 publications. We then excluded case studies (n=23), reviews or theoretical works (n=192), studies involving data from clinical samples (n=244), qualitative studies (n=26), studies that used a compulsive buying scale to determine shopping severity but didn’t report a prevalence rate (n=73), studies written in a foreign language (n=15), dissertations and conference abstracts (n=7), studies written in a foreign language (n=15), small studies with a sample size of below 145 participants (n=16), and studies involving adolescents (n=2). This left 40 studies that met the inclusion criteria for the review. We then extracted sample mean age, proportion of females (in %), the study’s geographical location, and the screening instrument used to assess CBB, and the reported prevalence estimate of CBB.

The 40 relevant studies identified reported 49 different prevalence rate estimates for 32,333 participants. We then divided the data into four sub-samples: adult representative, adult non-representative, university student and shopping-specific. The mean prevalence of compulsive buying was 4.9% in adult representative samples [10,102 participants], 12.3% in adult non-representative samples [3,929 participants], 8.3% in university student samples [14,947 participants] and 16.2% in shopping-specific samples [4,686 participants]. Unsurprisingly, the highest prevalence rates were among shopping-specific samples.

We noted that the heterogeneity in prevalence rates of CBB may be because of the lack of consensus regarding the definition of compulsive buying. Studies used different measures to assess CBB, each having a different conceptual background. Most definitions include cognitive-affective indicators as well as maladaptive behavioural consequences when defining the disorder (e.g., debts). The screening instruments used across studies differed in indicators of financial consequences (e.g., credit card use, debts, loan etc.) and are subject to differences according to countries, sub-cultures and/or age groups.

Another problem we identified was that measures used to assess CBB didn’t explicitly distinguish current and lifetime assessment of CBB. Prevalence rates assessed with an instrument that assessed lifetime prevalence report 1.6 times higher rates on average than those that assessed current prevalence. We also observed that non-representative samples (e.g., adults, university students, shoppers) tended to recruit younger participants who were more likely to be female than representative studies. However, we also noted that the mean age of the sample and the proportion of males and females did not have a reliable effect on the prevalence estimates.

Being of a younger age was predictive of CBB according to individual study results and also according to the regression analysis that we carried out in the representative samples. However, it remains open as to whether compulsive buying tendency decreases with age or this difference reflects generational differences. If the latter was the case, then the prevalence of compulsive buying behaviour is expected to increase in the future. We also found some evidence for increasing rates of CBB in Germany and in Spain, but longitudinal studies are needed to clarify this.

In relation to data collection, estimates from the United States (18 out of 49) were over-represented compared to countries other than the USA, although there was no difference in the reported estimates between the U.S. and non-U.S. countries. However, it is difficult to draw reliable conclusions regarding the cultural variance of CBB given that adult representative estimates are only available from the USA, Spain, Germany and Hungary.

The fact that compulsive buying behaviour is a relatively common disorder with severe consequences for a minority of individuals should not be overlooked. It appears that approximately one in 20 individuals suffer from CBB at some point in their lives and that being young and female are associated with a higher risk of CBB. High heterogeneity is likely to be the result of methodological variability within studies, such as assessment screens with different time frames and conceptual background. We concluded that future studies should therefore think carefully about how to conceptualise the disorder and to clearly separate out current versus lifetime prevalence in the samples used.

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

Please note : This article was co-written with Aniko Maraz and Zsolt Demetrovics (Institute of Psychology, Eötvös Loránd University, Budapest, Hungary)

Further reading

Alemis, M. C., & Yap, K. (2013). The role of negative urgency impulsivity and financial management practices in compulsive buying. Australian Journal of Psychology, 65(4), 224-231.

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Basu, B., Basu, S., & Basu, J. (2011). Compulsive buying: an overlooked entity. Journal of the Indian Medical Association, 109(8), 582-585.

Black, D.W., Shaw, M., McCormick, B., Bayless, J.D., Allena, J. (2012). Neuropsychological performance, impulsivity, ADHD symptoms, and novelty seeking in compulsive buying disorder. Psychiatry Research, 200, 581–587.

Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6, 14-18.

Davenport, K., Houston, J.E., Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474–489.

Dittmar, H., Long, K. & Bond, R. (2007). When a better self is only a button click away: Associations between materialistic values, emotional and identity-related buying motives, and compulsive buying tendency online. Journal of Social and Clinical Psychology, 26, 334-361.

Duroy, D., Gorse, P., & Lejoyeux, M. (2014). Characteristics of online compulsive buying in Parisian students. Addictive Behaviors, 39, 1827-1830.

Frost, R.A., Tolin, D.F., Steketee, G., Fitch, K.E., Selbo-Bruns, A. (2009). Excessive acquisition in hoarding, Journal of Anxiety Disorders, 23, 632-639.

Guo, Z., Cai, Y. (2011). Exploring the antecedents of compulsive buying tendency among adolescents in China and Thailand: A consumer socialization perspective. African Journal of Business Management, 5(24), 10198-10209.

Harvanko, A., Lust, K., Odlaug, B. L., Schreiber, L., Derbyshire, K., Christenson, G., & Grant, J. E. (2013). Prevalence and characteristics of compulsive buying in college students. Psychiatry Research, 210(3), 1079-1085.

Jung, J., & Yi, S. (2013). Assessment of heterogeneity of compulsive buyers based on affective antecedents of buying lapses. Addiction Research and Theory, 22, 37-48.

Koran, L.M., Faber, R.J., Aboujaoude, M.A., Large, M.D., Serpe, R.T. (2006). Estimated prevalence of compulsive buying behavior in the United States. American Journal of Psychiatry, 163, 1806-1812.

Kukar-Kinney, M., Ridgway, N. M., & Monroe, K. B. (2012). The role of price in the behavior and purchase decisions of compulsive buyers. Journal of Retailing, 88(1), 63-71.

Lejoyeux, M., Weinstein, A. (2010). Compulsive buying. American Journal of Drug and Alcohol Abuse, 36 (5), 248–253.

Maraz, A., Griffiths, M. D., Demetrovics, Z. (2015). The prevalence of compulsive buying in nonclinical populations: a systematic review and meta-analysis. Addiction, doi:10.1111/add.13223.

Mikołajczak-Degrauwe, K., & Brengman, M. (2014). The influence of advertising on compulsive buying – The role of persuasion knowledge. Journal of Behavioral Addictions, 3(1), 65–73.

Mueller, A., Mitchell, J. E., Peterson, L. A., Faber, R. J., Steffen, K. J., Crosby, R. D., & Claes, L. (2011). Depression, materialism, and excessive Internet use in relation to compulsive buying. Comprehensive Psychiatry, 52(4), 420-424.

Tommasi, M., & Busonera, A. (2012). Validation of three compulsive buying scales on an Italian sample 1. Psychological Reports, 111(3), 831-844.

Weinstein, A., Maraz, A., Griffiths, M.D., Lejoyeaux, M. & Demetrovics, Z. (in press). Shopping addiction and compulsive buying: Features and characteristics of addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse. London: Academic Press.

Tech’s appeal: Another look at Internet addiction

Generally speaking, Internet addiction (IA) has been characterized by excessive or poorly controlled preoccupation, urges, and/or behaviours regarding Internet use that lead to impairment or distress in several life domains. However, according to Dr. Kimberly Young, IA is a problematic behaviour akin to pathological gambling that can be operationally defined as an impulse-control disorder not involving the ingestion of psychoactive intoxicants.

Following the conceptual framework developed by Young and her colleagues to understand IA, five specific types of distinct online addictive behaviours were identified: (i) ‘cyber-sexual addiction’, (ii) ‘cyber-relationship addiction’, (iii) ‘net compulsions (i.e., obsessive online gambling, shopping, or trading), (iv) ‘information overload’, and (v) ‘computer addiction’ (i.e., obsessive computer game playing).

However, I have argued in many of my papers over the last 15 years that the Internet may simply be the means or ‘place’ where the most commonly reported addictive behaviours occur. In short, the Internet may be just a medium to fuel other addictions. Interestingly, new evidence pointing towards the need to make this distinction has been provided from the online gaming field where new studies (including some I have carried out with my Hungarian colleagues) have demonstrated that IA is not the same as other more specific addictive behaviours carried out online (i.e., gaming addiction), further magnifying the meaningfulness to differentiate between what may be called ‘generalized’ and ‘specific’ forms of online addictive behaviours, and also between IA and gaming addiction as these behaviours are conceptually different.

Additionally, the lack of formal diagnostic criteria to assess IA holds another methodological problem since researchers are systematically adopting modified criteria from other addictions to investigate IA. Although IA may share some commonalities with other substance-based addictions, it is unclear to what extent such criteria are useful and suitable to evaluate IA. Notwithstanding the existing difficulties in understanding and comparing IA with behaviours such as pathological gambling, recent research provided useful insights on this topic.

A recent study by Dr. Federico Tonioni (published in a 2014 issue of the journal Addictive Behaviors) involving two clinical (i.e., 31 IA patients and 11 pathological gamblers) and a control group (i.e., 38 healthy individuals) investigated whether IA patients presented different psychological symptoms, temperamental traits, coping strategies, and relational patterns in comparison to pathological gamblers, concluded that Internet-addicts presented higher mental and behavioural disengagement associated with significant more interpersonal impairment. Moreover, temperamental patterns, coping strategies, and social impairments appeared to be different across both disorders. Nonetheless, the similarities between IA and pathological gambling were essentially in terms of psychopathological symptoms such as depression, anxiety, and global functioning. Although, individuals with IA and pathological gambling appear to share similar psychological profiles, previous research has found little overlap between these two populations, therefore, both phenomena are separate disorders.

Despite the fact that initial conceptualizations of IA helped advance the current knowledge and understanding of IA in different aspects and contexts, it has become evident that the field has greatly evolved since then in several ways. As a result of these ongoing changes, behavioural addictions (more specifically Gambling Disorder and Internet Gaming Disorder) have now recently received official recognition in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, IA can also be characterized as a form of technological addiction, which I have operationally defined as a non-chemical (behavioural) addiction involving excessive human-machine interaction. In this theoretical framework, technological addictions such as IA represent a subset of behavioural addictions featuring six core components: (i) salience, (ii) mood modification, (iii) tolerance, (iv) withdrawal, (v) conflict, and (vi) relapse. The components model of addiction appears to be a more updated framework for understanding IA as a behavioural addiction not only conceptually but also empirically. Moreover, this theoretical framework has recently received empirical support from several studies, further evidencing its suitability and applicability to the understanding of IA.

For many in the IA field, problematic Internet use is considered to be a serious issue – albeit not yet officially recognised as a disorder – and has been described across the literature as being associated with a wide range of co-occurring psychiatric comorbidities alongside an array of dysfunctional behavioural patterns. For instance, IA has been recently associated with low life satisfaction, low academic performance, less motivation to study, poorer physical health, social anxiety, attention deficit/hyperactivity disorder and depression, poorer emotional wellbeing and substance use, higher impulsivity, cognitive distortion, deficient self-regulation, poorer family environment, higher mental distress, loneliness, among other negative psychological, biological, and neuronal aspects.

In a recent systematic literature review conducted by Dr. Wen Li and colleagues (and published in the journal Computers and Human Behavior), the authors reviewed a total of 42 empirical studies that assessed the family correlates of IA in adolescents and young adults. According to the authors, virtually all studies reported greater family dysfunction amongst IA families in comparison to non-IA families. More specifically, individuals with IA exhibited more often (i) greater global dissatisfaction with their families, (ii) less organized, cohesive, and adaptable families, (iii) greater inter-parental and parent-child conflict, and (iv) perceptions of their parents as more punitive, less supportive, warm, and involved. Furthermore, families were significantly more likely to have divorced parents or to be a single parent family.

Another recent systematic literature review conducted by Dr. Lawrence Lam published in the journal Current Psychiatry Reports examined the possible links between IA and sleep problems. After reviewing seven studies (that met strict inclusion criteria), it was concluded that on the whole, IA was associated with sleep problems that encompassed subjective insomnia, short sleep duration, and poor sleep quality. The findings also suggested that participants with insomnia were 1.5 times more likely to be addicted to the Internet in comparison to those without sleep problems. Despite the strong evidence found supporting the links between IA and sleep problems, the author noted that due to the cross-sectional nature of most studies reviewed, the generalizability of the findings was somewhat limited.

IA is a relatively recent phenomenon that clearly warrants further investigation, and empirical studies suggest it needs to be taken seriously by psychologists, psychiatrists, and neuroscientists. Although uncertainties still remain regarding its diagnostic and clinical characterization, it is likely that these extant difficulties will eventually be tackled and the field will evolve to a point where IA may merit full recognition as a behavioural addiction from official medical bodies (ie, American Psychiatric Association) similar to other more established behavioural addictions such as ‘Gambling Disorder’ and ‘Internet Gaming Disorder’. However, in order to achieve official status, researchers will have to adopt a more commonly agreed upon definition as to what IA is, and how it can be conceptualized and operationalized both qualitatively and quantitatively (as well as in clinically diagnostic terms).

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

Please note: This article was co-written with Halley Pontes and Daria Kuss.

Further reading

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 Workplace Learning, 7, 463-472.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Király, O., Griffiths, M.D., Urbán, R., Farkas, J., Kökönyei, G. Elekes, Z., Domokos Tamás, D. & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior and Social Networking, 17, 749-754.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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.

Lam, L.T. (2014). Internet Gaming Addiction, Problematic use of the Internet, and sleep problems: A systematic review. Current Psychiatry Reports, 16(4), 1-9.

Li, W., Garland, E.L., & Howard, M.O. (2014). Family factors in Internet addiction among Chinese youth: A review of English-and Chinese-language studies. Computers in Human. Behavior, 31, 393-411.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Tonioni, F., Mazza, M., Autullo, G., Cappelluti, R., Catalano, V., Marano, G., … & Lai, C. (2014). Is Internet addiction a psychopathological condition distinct from pathological gambling?. Addictive Behaviors, 39(6), 1052-1056.

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

Young, K. (1998). Caught in the net. New York: John Wiley

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

We can work it out: A brief look at ‘study addiction’

In today’s modern society, students face multiple academic pressures. The best colleges and universities require the best grades for entry and parents push and expect their children to succeed educationally. At school, pupils learn early on that success comes through dedication, discipline, and hard work. For some individuals, the act of educational study may become excessive and/or compulsive and lead to what has been termed ‘study addiction’.

Although there is little research and no generally accepted definition of study addiction to date, such behaviour (as a way of dealing with academic stress and pressure) has been conceptualized within contemporary research into workaholism. Consequently, from a ‘work addiction’ (i.e., workaholism) perspective, study addiction was defined by Dr. Cecilie Andreassen and her colleagues in a 2014 issue of the Journal of Managerial Psychology as: “Being overly concerned with studying, to be driven by an uncontrollable studying motivation, and to put so much energy and effort into studying that it impairs private relationships, spare-time activities, and/or health”.

The many similarities between studying and working lead to the notion that study addiction may be a precursor for or an early form of workaholism that might manifest itself in childhood or adolescence. Work appears to share many similarities to that of learning and studying, as both involve sustained effort in order to achieve success, often related to skills and knowledge, and both fulfill important social roles. In previous studies (including some of my own – see ‘Further reading’ below), workaholism has been shown to be a relatively stable entity over time. This suggests that the behavioural tendency to work excessively may be manifesting itself early in the development of an individual in relation to learning and associated academic behaviours. Given the similarities between excessive work and excessive study, there is no theoretical reason to believe that ‘study addiction’ (like work addiction) does not exist.

Given that most scales to assess workaholism have been developed without adequate consideration of all facets of addiction, my colleagues and I developed the Bergen Work Addiction Scale (BWAS). This was published in a 2012 issue of the Scandinavian Journal of Psychology and was developed to overcome the theoretical and conceptual weaknesses of previous instrumentation. This BWAS assesses core elements of addiction (salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems). As no current measure of study addiction exists, we adapted the BWAS by replacing the words ‘work’ and ‘working’ with ‘study’ and ‘studying’ (creating the Bergen Study Addiction Scale) and carried out the first ever study on ‘study addiction’ and some of the results of this study that have just been published in the Journal of Behavioral Addictions are highlighted later in this article.

Unlike most other behavioural addictions (e.g., pathological gambling, video gaming addiction, shopping addiction, etc.), workaholism – like exercise addiction – has often been regarded as a positive and productive kind of addiction. Notably, workaholics typically score higher on personality traits such as conscientiousness and perfectionism compared to other addicts. As with the workaholic, the “perfect student” is hard working and involved, and it is likely that study addiction is also associated with conscientiousness. Along with the academic pressure derived from many differing sources (such as the fear of failure), it is also conceivable that such individuals – like workaholics – will score higher on neuroticism.

Although the societal notion of workaholism as a positive behaviour has received some support, most current scholars conceive it as a negative condition due to its association with impaired health, low perceived quality of life, diminished sleep quality, work-family conflicts, and lowered job performance. Given these well-established associations, we hypothesized in our study that extreme studying behaviour (i.e., study addiction) would be negatively related to psychological wellbeing, health, and academic performance, and positively related to stress.

On the basis of previous theoretical frameworks and empirical research into work addiction, we hypothesized that study addiction would be (i) positively and significantly associated with conscientiousness and neuroticism, (ii) positively and significantly associated with stress, and lower quality of life, health, and sleep, and (iii) negatively and significantly related to academic performance. Our study comprised two samples of students (n=1,211). The first sample comprised 218 first-year psychology undergraduate students at the University of Bergen in Norway. The second sample comprised 993 participants studying at three Polish universities.

We found there were positive associations between study addiction, neuroticism and conscientiousness, and lack of relationship with agreeableness (in both the Polish and Norwegian samples). In the Polish sample, extraversion was negatively related to study addiction. Our results also showed that study addiction was positively related to perceived stress and negatively associated with general quality of life, general health, and sleep quality above and beyond personality factors. These results parallel current knowledge about negative correlates of work addiction. When controlling for personality traits, study addiction was negatively associated with immediate academic performance (although not statistically significant in the Norwegian sample, probably due to the relatively small sample size in terms of exam results compared to the much bigger Polish sample).

As expected, study addiction was related to several negative consequences and problems. Although our results were interesting and (on the whole supported our hypotheses) the two groups of students comprised convenience samples, were predominantly female, and mainly comprised psychology and education students. Therefore, the results of our study cannot be generalized to other populations. However, our study is first ever study to conceptualize ‘study addiction’ and to test psychometric properties of a corresponding measurement tool (which for all you psychometricians out there had good reliability and validity). We also used several variables comprising possible antecedents and consequences of study addiction, including valid and reliable measures of personality, psychological wellbeing, health, stress, and academic performance. We believe that our study significantly adds to the existing literature on workaholism and behavioural addictions, and our initial findings appear to support the concept of study addiction and provide an empirical base for its further investigation.

If we had an unlimited research budget, we’d like to carry out longitudinal studies in younger samples (e.g., high school) as such data would likely provide useful information in terms of possible developmental risk factors, determinants, and correlates of study addiction. The relationship between study addiction and later work addiction should also be investigated longitudinally in order to investigate if these are aspects are part of the same phenomenon and/or pathological process.

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

Please note; This article was written in conjunction with Paweł Atroszko University of Gdańsk, Poland), Cecilie Schou Andreassen (University of Bergen, Norway), and Ståle Pallesen (University of Bergen, Norway).

Further reading

Andreassen, C. S. (2014). Workaholism: An overview and current status of the research. Journal of Behavioral Addictions, 3, 1-11.

Andreassen, C., Griffiths, M., Gjertsen, S., Krossbakken, E., Kvam, S., & Pallesen, S. (2013). The relationships between behavioral addictions and the five-factor model of personality. Journal of Behavioral Addictions, 2, 90-99.

Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: a survey study in a nationally representative sample of norwegian employees. PLoS One, 9, e102446. doi: 10.1371/journal.pone.0102446

Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265-272.

Andreassen, C. S., Hetland, J., & Pallesen, S. (2014). Psychometric assessment of workaholism measures. Journal of Managerial Psychology, 29, 7-24.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

Burke, R. J., Matthiesen, S. B., & Pallesen, S. (2006). Personality correlates of workaholism. Personality and Individual Differences, 40, 1223-1233.

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

Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Quinones, C. & Mark D. Griffiths (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

Spence, J. T., & Robbins, A. S. (1992). Workaholism – definition, measurement, and preliminary results. Journal of Personality Assessment, 58, 160-178.

van Beek, I., Taris, T. W., & Schaufeli, W. B. (2011). Workaholic and work engaged employees: dead ringers or worlds apart? Journal of Occupational Health Psychology, 16, 468-482.

Are you ‘intexticated’?: Another look at excessive smartphone use

Yesterday, I received a copy of a new book called Too Much Of A Good Thing: Are You Addicted To Your Smartphone? by Dr. James Roberts (a Professor of Marketing at Baylor University in Waco, Texas). It’s a populist and easy-to-read book that you can read from cover to cover inside two hours. It’s not an academic book but there’s lots of input from various academics around the world (including me – which is why I was sent a copy of the book). It’s a fun read and is written by someone (who like myself) loves technology and all the great benefits it brings us.

The main thrust of the book doesn’t concern addiction per se, but is more concerned with how smartphones take us away from or compromises other things in our lives like our friends, our loved ones, our hobbies and (in extreme cases) our jobs. Roberts describes this as ‘cellularitis’ – “a Socially Transmitted Disease (STD) that results in habitual use of one’s cell phone to the detriment of his or her psychological and physical health and well-being”. In the second chapter, Dr. Roberts uses my addiction components model to describe his ‘Six Signs of Cell Phone Addiction Scale’ (although uses an older version of the components model taken from a paper I published on internet addiction back in 1999 in The Psychologist).

One of the chapters on the phenomena of ‘phubbing’ (i.e., phone snubbing – where someone you are socially interacting with would rather be on their smartphone, rather than talking to you). One recent paper by Dr. Roberts published in the journal Computers in Human Behavior even had the title ‘My life has become a major distraction from my cell phone’. The chapter also contains a 9-item ‘Phubbing Scale’ that Roberts developed with his colleague Dr. Meredith David (and a later chapter also includes the ‘Partner Phubbing Scale’). Academic research into phubbing has already started (see ‘Further reading below) and I’ll hopefully write a blog on that in the future. I also liked the concept of being ‘intexticated’ defined as being “distracted by the act of texting to such a degree that one seems intoxicated”.

In previous blogs I have examined the concept of mobile phone addiction, the most recent of which argued that there was nowhere near enough empirical evidence to be able to confirm whether addiction to smartphones exists. Dr. Roberts asked me about the topic for his book and here are the answers to the questions he asked me.

Can someone be addicted to their cell phone? Why or why not?

That depends on how ‘addiction’ is defined. I believe that anything can be potentially addictive if constant rewards and reinforcement are present. Some people may confuse habitual use of such technology as an addictive behaviour (when in reality it may not be). For instance, some people may consider themselves cell phone addicts because they never go out of the house without their cell phone, do not turn their cell phone off at night, are always expecting calls from family members or friends, and/or over-utilise cell phones in their work and/or social life. There is also the importance of economic and/or life costs. The crucial difference between some forms of cell phone use and pathological cell phone use is that some applications involve a financial cost. If a person is using the application more and is spending more money, there may be negative consequences as a result of not being able to afford the activity (e.g., negative economic, job-related, and/or family consequences). High expenditure may also be indicative of cell phone addiction but the phone bills of adolescents are often paid for by parents, therefore the financial problems may not impact on the users themselves.

It is very difficult to determine at what point cell phone use becomes an addiction. The cautiousness of researchers suggests that we are not yet in a position to confirm the existence of a serious and persistent psychopathological addictive disorder related to cell phone addiction on the basis of population survey data alone. This cautiousness is aided and supported by other factors including: (a) the absence of any clinical demand in accordance with the percentages of problematic users identified by these investigations, (b) the fact that the psychometric instruments used could be measuring ‘concern’ or ‘preoccupation’ rather than ‘addiction, (c) the normalisation of behaviour and/or absence of any concern as users grow older; and (d) the importance of distinguishing between excessive use and addictive use.

What signs or symptoms would you look for when deciding if someone is addicted to their cell phone?

You could argue that a person is no more addicted to their phone than an alcoholic is addicted to the bottle. Individuals tend to have addictions on their mobile phone rather than to their phone. For me to class someone as addicted to their mobile phone they would have to fulfill the following six criteria:

• Salience – This occurs when the mobile phone use 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 socialised behaviour). For instance, even if the person is not actually on their phone they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with their mobile phone).
• Mood modification – This refers to the subjective experiences that people report as a consequence of mobile phone use 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’) when on the phone.
• Tolerance – This is the process whereby increasing amounts of mobile phone use are mobile phone users gradually build up the amount of the time they spend on their phone 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 use their phone because there is no signal, mislaid or broken phone, etc.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much on their mobile phone.
• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive mobile phone use to recur and for even the most extreme patterns typical of the height of excessive mobile phone use to be quickly restored after periods of control.

What is one suggestion you could offer to help someone better control their cell phone use?

I don’t have a single suggestion. If there was a single suggestion to overcome or better control problematic phone use then I could give up my whole research career. However, my tips on digital detox can be found here.

 

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

Further reading

Bianchi, A. & Phillips, J.G. (2005). Psychological predictors of problem mobile phone use. Cyberpsychology and Behavior, 8, 39–51.

Billieux, J. (2012). Problematic use of the mobile phone: A literature review and a pathways model. Current Psychiatry Reviews, 8, 299–307.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioural addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, DOI 10.1007/s40429-015-0054-y

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Obert, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Chóliz M. (2010). Mobile phone addiction: a point of issue. Addiction. 105, 373-374.

Griffiths, M.D. (1999). Internet addiction: Fact or fiction? The Psychologist: Bulletin of the British Psychological Society, 12, 246-250.

Griffiths, M.D. (2007). Mobile phone gambling. In D. Taniar (Ed.), Encyclopedia of Mobile Computing and Commerce (pp.553-556). Pennsylvania: Information Science Reference.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Karadağ, E., Tosuntaş, Ş. B., Erzen, E., Duru, P., Bostan, N., Şahin, B. M., … & Babadağ, B. (2015). Determinants of phubbing, which is the sum of many virtual addictions: A structural equation model. Journal of Behavioral Addictions, 4, 60-74.

Lopez-Fernandez, O., Honrubia-Serrano, L., Freixa-Blanxart, M., & Gibson, W. (2014). Prevalence of problematic mobile phone use in British adolescents. Cyberpsychology, Behavior and Social Networking, 17, 91-98.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (in press). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3). Hershey, PA: IGI Global.

Roberts, J.A. (2016). Too Much Of A Good Thing: Are You Addicted To Your Smartphone? Austin: Sentia Publishing.

Roberts, J. A., & David, M. E. (2016). My life has become a major distraction from my cell phone: Partner phubbing and relationship satisfaction among romantic partners. Computers in Human Behavior, 54, 134-141

Smetaniuk, P. (2014). A preliminary investigation into the prevalence and prediction of problematic cell phone use. Journal of Behavioral Addictions, 3(1), 41-53.

Ugur, N. G., & Koc, T. (2015). Time for digital detox: Misuse of mobile technology and phubbing. Procedia-Social and Behavioral Sciences, 195, 1022-1031.

Naming desire: A personal look at my new job title

Back in 2002, I was incredibly proud when I became one of the youngest full Professors in the UK when I was bestowed the title of Professor of Gambling Studies based on my research contribitions to the gambling studies field. Anyone that has followed my career over the last decade (or this blog over the last four years) will no doubt have realised that my research interests and expertise include a lot more than gambling.

Although I still publish a lot of papers on gambling (12 to 17 papers per calendar year; see Appendix 1 below) I have carried out more and more research into non-gambling addictions and over the last six years (2010-2015) my refereed journal outputs on gambling have only constituted one-third of all my refereed journal outputs (32%) (see Appendix 1 and Figure 1).

The overwhelming majority of my published refereed papers since January 2010 (n=246; 88%) concern behavioural addictions (i.e., gambling addiction, videogame addiction, internet addiction, work addiction, sex addiction, exercise addiction, shopping addiction, dancing addiction, etc.). If gambling addiction is removed from these papers, this still leaves 56% of all my papers during the 2010-2015 period concerning other behavioural addictions (n=158). The remainder of my refereed journal papers (34 papers; 12%) mainly concern the topic of mindfulness carried out with my colleagues Edo Shonin and William Van Gordon. Even my three books in the 2010-2105 timeframe have been on three totally separate topics (i.e., problem gambling, internet addiction and mindfulness). Of my 71 book chapters in this 2010-2015 period, 22 have been on gambling addiction, 41 have been on other behavioural addictions, and 8 have concerned other topics (see Figure 2). In the ‘Further reading’ section below is some of the papers that I have published this year and even a quick glance will highlight that gambling papers are in the minority.

It is also worth noting that I am one of the most highly cited academics in the UK (soemthig else that I am very proud of) and a quick look at my Google Scholar citations profile (currently over 24,500 citations as of October 31, 2015) that of my top ten most highly cited papers, only one is on gambling adiction and the other nine concern my papers on videogame addiction and internet addiction.

Basically, my job title didn’t reflect what I was actually doing on the research front. And this is the very argument I put to my employer (Nottingham Trent University) a number of weeks ago. As far as I am aware, I am the first professor at NTU to ever ask for my title to be changed but last week I was informed by my line manager that the university was convinced by the case I put forward and from now on I will be Professor of Behavioural Addiction.

This new title change has pleased me greatly and of course subsumes the vast majority of the research that I am doing (including my research into gambling addiction). I don’t think I will ever stop carrying out research in the gambling field but my new job title will stop me feeling guilty about working in non-gambling areas. It may also stop some of few abusive emails I get regarding my blogs (saying in very colourful language that I should stop writing about other behavioural addictions and sexual paraphilias and “write about what I get paid to do”). Firstly, I would point out to these individuals that I don’t get paid to write my personal blog and even if I did, I write all my blogs in my spare time.

If you’ve read this far, then thank you. I promise normal service will be resumed in my next blog when it will be about something other than myself.

Appendix 1: Summary statistics of my refereed journal papers (January 1, 2010 to October 20, 2015)

• 2010: Gambling papers (n=17); Behavioural addiction papers (n=19); Other papers (n=1)
• 2011: Gambling papers (n=15); Behavioural addiction papers (n=15); Other papers (n=2)
• 2012: Gambling papers (n=10); Behavioural addiction papers (n=28); Other papers (n=3)
• 2013: Gambling papers (n=12); Behavioural addiction papers (n=23); Other papers (n=4)
• 2014: Gambling papers (n=13); Behavioural addiction papers (n=33); Other papers (n=13)
• 2015: Gambling papers (n=13); Behavioural addiction papers (n=27); Other papers (n=7)
• In press: Gambling papers (n=8); Behavioural addiction papers (n=13); Other papers (n=4)

 

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

Further reading (some recent papers)

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

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

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

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Canale, N. Santinello, M. & Griffiths, M.D. (2015). Validation of the Reasons for Gambling Questionnaire (RGQ) in a British population survey. Addictive Behaviors, 45, 276-280.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). Trait urgency and gambling problems in young people: the role of decision-making processes. Addictive Behaviors, 46, 39-44.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits. Psychology of Addictive Behaviors, 29, 813–823.

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Dhuffar, M. & Pontes, H.M. & Griffiths, M.D. (2015). Dysphoric mood states and consequences of sexual behaviours as predictors of hypersexual behaviours in university students: An exploratory study. Journal of Behavioural Addictions, 4, 181–188.

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Griffiths, M.D. (2015). Problematic technology use during adolescence: Why don’t teenagers seek treatment? Education and Health, 33, 6-9.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Hussain, Z., Williams, G. & Griffiths, M.D. (2015). An exploratory study of the association between online gaming addiction and enjoyment motivations for playing massively multiplayer online role-playing games. Computers in Human Behavior, 50, 221–230.

Karanika-Murray, M., Pontes, H.M., Griffiths, M.D. & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science and Medicine, 139, 100-106.

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Urbán, R., Griffiths, M.D., Ágoston, C., Nagygyörgy, K., Kökönyei, G. & Demetrovics, Z. (2015). Psychiatric symptoms and problematic online gaming: The mediating effect of gaming motivation. Journal of Medical Internet Research, 17(4) :e88.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Quinones, C. & Mark D. Griffiths (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

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.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

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.

Good buy to love: Introducing the Bergen Shopping Addiction Scale

(Please note that the following article was co-written using material provided by my research colleague Dr. Cecilie Schou Andreassen and our fellow researchers).

In two of my previous blogs I took a brief look at the area of shopping addiction (that you can read here and here). Since writing those blogs I’ve co-written a few papers on compulsive buying and shopping addiction (see ‘Further reading’ below), the latest of which was published in the journal Frontiers in Psychology (FiP) and led by my friend and research colleague Dr. Cecilie Schou Andreassen at the University of Bergen in Norway. In the FiP paper we reported on the development of a newly created instrument to assess this disorder called the Bergen Shopping Addiction Scale (BSAS).

Whether compulsive and excessive shopping represents an impulse-control, obsessive-compulsive or addictive disorder has been debated for several years This fact is reflected in the many names that have been given to this disorder including ‘oniomania’, ‘shopaholism’, ‘compulsive shopping’, ‘compulsive consumption’, ‘impulsive buying’, “compulsive buying’ and ‘compulsive spending’. In a review by Dr. Andreasson in the Journal of Norwegian Psychological Association, she argued that shopping disorder is best understood from an addiction perspective, and defined it as “being overly concerned about shopping, driven by an uncontrollable shopping motivation, and to investing so much time and effort into shopping that it impairs other important life areas”. Several authors (including myself) share this view as a growing body of research shows that those with problematic shopping behaviour report specific addiction symptoms such as craving, withdrawal, loss of control, and tolerance.

Research also suggests that the typical shopping addict is young, female, and of lower educational background. Some personality factors have also been shown to be associated with shopping addiction including extroversion and neuroticism. It has been suggested that neurotic individuals (typically being anxious, depressive, and self-conscious) may use shopping as means of reducing their negative emotional feelings. Other personality factors may actually protect individuals from developing shopping addictions (e.g., conscientiousness). Empirical research (including some research I carried out with Kate Davenport and James Houston published in a 2012 issue of the International Journal of Mental Health and Addiction) has consistently reported significantly lower levels of self-esteem among shopping addicts. Such findings suggest that irrational beliefs such as “buying a product will make life better” and “shopping this item will enhance my self-image” may trigger excessive shopping behaviour in people with low self-esteem. However, this may be related to depression, which has been shown to be highly comorbid with problematic shopping.

Other factors, such as anxiety have also often been associated with shopping, and it has also been suggested that self-critical people shop in order to escape, or cope with, negative feelings. In addition, shopping addiction has also been explained (by such people as Dr. Marc Potenza and Dr. Eric Hollander) as a way of regulating neurochemical (e.g., serotonergic, dopaminergic, opioid) abnormalities and has been successfully treated with pharmacological agents, including selective serotonin reuptake inhibitors (SSRIs) and opioid antagonists.

One of the key problems that we outlined in our new FiP paper is that in prior research there is a lack of a common understanding about how problematic shopping should be defined, conceptualized, and measured. Consequently, there are huge disparities and unreliable prevalence estimates of shopping addiction ranging from 1% to 20% and beyond (depending upon the criteria used to assess the disorder). Although several scales for assessing shopping addiction have been developed (mainly in the late 1980s and early 1990s) many of them have poor theoretical anchoring and/or are primarily rooted within the impulse-control paradigm. We also argued that several items of existing scales are outdated with regards to modern consumer patterns (such as people using cheques or no reference to online shopping). Newer scales that have been developed don’t view problematic shopping behaviour as an addiction in terms of core addiction criteria (i.e., salience, mood modification, tolerance, withdrawal, conflict, relapse and resulting problems).

This is why we decided to develop a new shopping addiction scale (i.e., the BSAS) containing a small number of items that reflect the core elements of addiction (and if you want to take the test yourself, it’s at the end of this article). We examined the psychometric properties of the new scale among a large sample of Norwegian individuals (n=23,537), and the testing phase began with 28 items (four statements for each of the seven components of addiction outlined above). The BSAS was constructed simply by taking the highest scoring item from each of seven 4-item clusters. We found that scores on the BSAS were significantly higher among females, as well as being inversely related to age (and therefore in line with previous research). We also found that scores on the BSAS were positively associated with extroversion and neuroticism.

The association of shopping addiction with extroversion may reflect that, in general, extroverts need more stimulation than non-extroverted individuals, a notion that is in line with studies showing that extroversion is associated with addictions more generally. It may also reflect the notion that extroverts purchase specific types of products excessively as a means to express their individuality, enhance personal attractiveness, or as a way to belong to a certain privileged group a (e.g., the buying of high end luxury goods). The association of shopping addiction with neuroticism may be because neuroticism is a general vulnerability factor for the development of psychopathology and that people scoring high on neuroticism engage excessively in different behaviours in order to escape from dysphoric feelings.

We also found that shopping addiction was inversely related to self-esteem. This is also in line with the findings of previous studies and implies that some individuals shop excessively in order to obtain higher self-esteem (e.g., associated “rub-off” effects from high status items such as popularity, compliments, in-group ‘likes’, omnipotent feelings while buying items, attention during the shopping process from helping retail personnel), to escape from feelings of low self-esteem, or that shopping addiction lowers self-esteem. Obviously our new scale needs to be further evaluated in future studies (as it has only been investigated in this one study) and it also requires validation in other cultures.

Overall, we concluded that the BSAS has good psychometrics – basically the scale is quick to administer, reliable and valid. With the advent of new technology and modern consumer patterns we may be witnessing an increase in problematic shopping behaviour. It is likely that new Internet-related technologies can greatly facilitate the emergence of problematic shopping behaviour because of factors such as accessibility, affordability, anonymity, convenience, and disinhibition. Therefore, we encourage other researchers to consider using the BSAS in epidemiological studies and treatment settings.

Want to take the test?  

Answer each of the following questions with one of the following five responses: ‘completely disagree’, ‘disagree’, ‘neither disagree nor agree’, ‘agree’, and ‘completely agree’.

• You think about shopping/buying things all the time
• You shop/buy things in order to change your mood
• You shop/buy so much that it negatively affects your daily obligations (e.g., school and work)
• You feel you have to shop/buy more and more to obtain the same satisfaction as before.
• You have decided to shop/buy less, but have not been able to do so
• You feel bad if you for some reason are prevented from shopping/buying things
• You shop/buy so much that it has impaired your well-being

If you answer “agree” or “completely agree” on at least four of the seven items, you may be a shopping addict.

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

Further reading

Aboujaoude, E. (2014). Compulsive buying disorder: A review and update. Current Pharmaceutical Design, 20, 4021-4025.

Andreassen, C. S. (2014). Shopping addiction: An overview. Journal of Norwegian Psychological Association, 51, 194–209.

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Davenport, K., Houston, J. & Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474-489.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

McQueen, P., Moulding, R., & Kyrios, M. (2014). Experimental evidence for the influence of cognitions on compulsive buying. Journal of Behavior Therapy and Experimental Psychiatry, 45, 496–501.

Workman, L., & Paper, D. (2010). Compulsive buying: A theoretical framework. Journal of Business Inquiry, 9, 89–126.

Term warfare: Internet Gaming Disorder and Internet Addiction Disorder are not the same

Over the last 15 years, research into various online addictions has greatly increased. Alongside this, there have been scholarly debates about whether internet addiction really exists. Some may argue that because internet use does not involve the ingestion of a psychoactive substance, then it should not be considered a genuine addictive behaviour. However, the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) re-classified ‘Gambling Disorder’ as a behavioural addiction rather than as a disorder of impulse control. The implications of this reclassification are potentially far-reaching. The most significant implication is that if an activity that does not involve the consumption of drugs (i.e., gambling) can be a genuine addiction accepted by the psychiatric and medical community, there is no theoretical reason why other problematic and habitual behaviours (e.g., shopping, work, exercise, sex, video gaming, etc.) cannot be classed as a bone fide addiction.

There have also been debates among scholars that consider excessive problematic internet use to be a genuine addiction as to whether the those in the field should study generalized internet addiction (the totality of all online activities) and/or specific addictions on the internet such as internet gambling, internet gaming and internet sex. Since the late 1990s, I have constantly argued that there is a fundamental difference between addictions on the internet, and addictions to the internet. I argued that the overwhelming majority of individuals that were allegedly addicted to the internet were not internet addicts but were individuals that used the medium of the internet as a vehicle for other addictions. More specifically, I argued that internet gambling addicts and internet gaming addicts were not internet addicts but were gambling and gaming addicts using the convenience and ubiquity of the internet to gamble or play video games.

Prior to the publication of the latest DSM-5, there had also been debates as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. However, far from clarifying the debates surrounding generalized versus specific internet use disorders, the section of the DSM-5 discussing IGD noted that:

“There are no well-researched subtypes for Internet gaming disorder to date. Internet gaming disorder most often involves specific Internet games, but it could involve non-Internet computerized games as well, although these have been less researched. It is likely that preferred games will vary over time as new games are developed and popularized, and it is unclear if behaviors and consequence associated with Internet gaming disorder vary by game type…Internet gaming disorder has significant public health importance, and additional research may eventually lead to evidence that Internet gaming disorder (also commonly referred to as Internet use disorder, Internet addiction, or gaming addiction) has merit as an independent disorder” (p.796).

In light of what has been already highlighted in previous research, two immediate problematic issues arise from these assertions. Firstly, IGD is clearly seen as synonymous with internet addiction as the text claims that internet addiction and internet use disorder are simply other names for IGD. Secondly – and somewhat confusingly – it is asserted that IGD (which is by definition internet-based) can also include offline gaming disorders.

With regards to the first assertion, internet addiction and online gaming addiction are not the same. A number of recent studies (including ones I’ve co-authored) clearly shows that to be the case. The second assertion that IGD can include offline video gaming is both baffling and confusing. Some researchers consider video games as the starting point for examining the characteristics of gaming disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. For instance, I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. For me, IGD is clearly a sub-type of video game addiction. For people like Dr. Kimberley Young, ‘cyber-relationship addictions’, ‘cyber-sexual addictions’, ‘net compulsions’ (gambling, day trading) and ‘information overload’ are all internet addictions. However, many would argue that these – if they are addictions – are addictions on the internet, not to it. The internet is a medium and it is a situational characteristic. The fact that the medium might enhance addictiveness or problematic behaviour does not necessarily make it a sub-type of internet addiction.

However, recent studies have made an effort to integrate both approaches. For instance, some researchers claim that neither the first nor the second approach adequately captures the unique features of Massively Multiplayer Online Role-Playing Games (MMORPGs), and argue an integrated approach is a necessity. A common observation is that “Internet users are no more addicted to the Internet than alcoholics are addicted to bottles”. The internet is just a channel through which individuals may access whatever content they want (e.g., gambling, shopping, chatting, sex). On the other hand, online games differ from traditional standalone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players. Consequently, it could be argued that IGD can either be viewed as a specific type of video game addiction, or as a variant of internet addiction, or as an independent diagnosis. However, the idea that IGD can include offline gaming disorders does little for clarity or conceptualization.

Finally, it is also worth mentioning that there are some problematic online behaviours that could be called internet addictions as they can only take place online. The most obvious activity that fulfills this criterion is social networking as it is a ‘pure’ online activity and does not and cannot take place offline. Other activities such as gambling, gaming, and shopping can still be engaged in offline (as gamblers can go to a gambling venue, gamers can play a standalone console game, shoppers can go to a retail outlet). However, those engaged in social networking would not (if unable to access the internet) walk into a big room of people and start chatting to them all. However, even if social networking addiction is a genuine internet addiction, social networking itself is still a specific online application and could still be considered an addiction on the internet, rather than to it.

Based on recent empirical evidence, IGD (or any of the alternate names used to describe problematic gaming) is not the same as Internet Addiction Disorder. The gaming studies field needs conceptual clarity but as demonstrated, the DSM-5 itself is both misleading and misguided when it comes to the issue of IGD.

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

Further reading

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

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

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

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

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

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

King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S.^, Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

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.

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

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Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Pontes, H., Király, O. Demetrovics, Z. & Griffiths, M.D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

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Rush hour: Can you be addicted to adrenaline?

(N.B. A shorter version of this article was first published in Hopes & Fears magazine).

Conceptualising addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. However, there is now a growing movement that views a number of behaviors as potentially addictive including those that do not involve the ingestion of a drug. These include behaviors diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. The term ‘adrenaline junkies’ has now passed into popular usage and usually refers to potentially dangerous activities such as bungee jumping, sky diving, BASE jumping, etc. My own view is that any activity that features continuous rewards (i.e., constant reinforcement) could be potentially addictive. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioral – 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 behavior (deterioration of socialized behavior). 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 short, if any ‘adrenaline junkies’ fulfilled all my six criteria I would class them as an addict. However, I have come across very few adrenaline junkies that endorse all of my six criteria. My position is that it is theoretically possible for individuals to become addicted to adrenaline producing activities but in reality, very few actually are.

Addiction is an incredibly complex behavior 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 behavior. In respect to ‘adrenaline addicts’ the most important factors are likely to be the individual’s personality and the potential of the reinforcing nature of the activity to produce mood modifying experiences.

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.