Against all odds: The rise and rise of gambling

In many areas of the world, gambling has become a popular activity. Almost all national surveys into gambling have concluded that most people have gambled at some point in their lives, there are more gamblers than non-gamblers, but that most participants gamble infrequently. Commissions and official government reviews in a number of countries including the United States, United Kingdom, Australia and New Zealand have all concluded that increased gambling availability has led to an increase in problem gambling. Estimates of the number of problem gamblers vary from country to country but most countries that have carried out national prevalence surveys suggest around 0.5%-2% of individuals have a gambling problem.

In May 2013, the new criteria for problem gambling (now called ‘Gambling Disorder’) were published in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-5), and for the very first time, problem gambling was included in the section ‘Substance-related and Addiction Disorders’ (rather than in the section on impulse control disorders). Also included in the Appendix of the DSM-5 as a potential addiction was Internet Gaming Disorder (i.e., online video game addiction). Although most of us in the field had been conceptualizing problematic gambling and video gaming as addictions for many years, this was arguably the first time that an established medical body had described them as such. For me, gambling and gaming addictions should not be considered any differently from other more traditional chemical addictions (e.g., alcohol addiction, nicotine addiction). Consequently, there is no theoretical reason why other problematic and excessive activities that do not involve the ingestion of a psychoactive substance cannot be deemed as legitimate behavioural addictions in the years to come (e.g., shopping addiction, sex addiction, work addiction, exercise addiction, etc.).

Gambling is a multifaceted rather than unitary phenomenon. Consequently, many factors are involved in the acquisition, development and maintenance of gambling behaviour. Such factors include an individual’s biological and genetic predisposition, their social environment, psychological variables (personality characteristics, attitudes, expectations, beliefs, etc.), macro-situational characteristics (how much gambling is marketed and advertised, the number of gambling venues within a jurisdiction, where the gambling venue is located), micro-situational characteristics of the gambling environment (on-site cash machine, provision of free alcohol, floor layout etc.), and the structural characteristics of the gambling activity itself (jackpot size, stake size, the number of times a individual can gamble in a given time frame, etc.). Most research has tended to concentrate on individual characteristics (personality, genetics, family and peer influence) rather than situational and structural characteristics.

The introduction of national lotteries, the proliferation of slot machines, the expansion of casinos, and the introduction of new media in which to gamble (e.g., Internet gambling, mobile phone gambling, interactive television gambling, gambling via social networking sites), has greatly increased the accessibility and popularity of gambling worldwide, and as a result, the number of people seeking assistance for gambling-related problems. In addition, the rise of remote gambling via the internet and mobile phones has arguably changed the psychosocial nature of gambling. I have also published a number of studies showing that to vulnerable and susceptible individuals (e.g., problem gamblers, minors, the intoxicated, etc.), the medium of the internet may facilitate and fuel problematic and addictive behaviours.

There are many known factors that make online activity potentially problematic to a minority of individuals. This includes factors such as easy accessibility, affordability, anonymity, convenience, escape, and disinhibition. Some of these factors can change the psychological experience of gambling. For instance, gambling with virtual representations of money online lower the psychological value of the money and people tend to spend more with virtual representations of money than if they were gambling with physical money. Also, when people lose money online it is a different psychological experience because no-one can see anyone losing face-to-face. As a result, there is less guilt and embarrassment about losing and vulnerable individuals may be tempted to spend more time and money than they had originally intended.

One very salient trend that has implications for gambling (and arguably problem gambling) is that technology hardware is becoming increasingly convergent (e.g., internet access via smartphones and interactive television) and there is increasing multi-media integration such as gambling and video gaming via social networking sites. As a consequence, people of all ages are spending more time interacting with technology in the form of internet use, playing videogames, watching interactive television, mobile phone use, social networking, etc. In addition to convergent hardware, there is also convergent content. This includes some forms of gambling including video game elements, video games including gambling elements, online penny auctions that have gambling elements, and television programming with gambling-like elements.

One of the key drivers behind the increased numbers of people gambling online and using social networking sites is the rise of mobile gambling and gaming. Compared to internet gambling, mobile gambling is still a relatively untapped area but the functional capabilities of mobile phones and other mobile devices are improving all the time. There are now hundreds of gambling companies that provide casino-style games to be downloaded onto the gambler’s smartphone or mobile device (e.g., tablet or laptop). This will have implications for the psychosocial impact of gambling and will need monitoring. Like online gambling, mobile gaming has the capacity to completely change the way people think about gambling and betting. Mobile phones provide the convenience of making bets or gambling from wherever the person is, even if they are on the move.

One of the most noticeable changes in gambling over the last few years – and inextricably linked to the rise of mobile gaming – has been the large increase of in-play sports betting. Gamblers can now typically bet on over 60 ‘in-play’ markets while watching a sports event (such as a soccer match). For instance, during a soccer game, gamblers can bet on who is going to score the first goal, what the score will be after 30 minutes of play, how many yellow cards will be given during them game and/or in what minute of the second half will the first free kick be awarded. Live betting is going to become a critical activity in the success of the future online and mobile gambling markets.

The most salient implication of ‘in-play’ sports betting is that it has taken what was traditionally a discontinuous form of gambling – where an individual makes one bet every Saturday on the result of the game – to one where an individual can gamble again and again and again. Gaming operators have quickly capitalized on the increasing amount of televised sport. In contemporary society, where there is a live sporting event, there will always be a betting consumer. ‘In-play’ betting companies have both catered for the natural betting demand but introduced new gamblers in the process. If the reward for gambling only happens once or twice a week, it is completely impossible to develop problems and/or become addicted. ‘In-play’ has changed that because there are soccer matches on almost every day of the week making a daily two-hour plus period of betting seven days a week.

New technologies in the form of behavioural tracking have helped online gambling companies keep track of players by noting (among many other things) what games they are playing, the time spent playing, the denomination of the gambles made, and their wins and losses. Although such technologies can potentially be used to exploit gamblers (e.g., targeting the heaviest spenders with direct marketing promotions to gamble even more), such technologies can also be used to help gamblers that may have difficulties stopping and/or limiting their gambling behaviour. Over the past few years, innovative social responsibility tools that track player behaviour with the aim of preventing problem gambling have been developed. These new tools are providing insights about problematic gambling behaviour. A number of European jurisdictions (such as Germany and The Netherlands) are now considering whether such tools should be mandatory for gaming operators to use especially as such tools are already being used in Sweden, Norway, Finland and Austria.

Although gamblers are ultimately responsible for their own behaviour, gambling can be minimised via both governmental policy initiatives (age restrictions, marketing and advertising restrictions, no gaming licenses unless operators display the highest standards of social responsibility to their clientele, etc.) and gaming operator initiatives (self-exclusion programs, information about games so gamblers can make informed choices, limit-setting tools that allow gamblers to set time and money loss limits, staff training on responsible gambling, referral to gambling treatment providers, etc.). Problem gambling can never be totally eliminated but harm minimisation practices can be put in place to keep the problem to a minimum. Treatment for gambling addiction should be free and paid for by gambling industry profits (either in the form of voluntary donations to a charitable trust or – if that doesn’t work – a statutory levy). In short, any jurisdiction that has legalised and liberalised gambling has a duty of care to put a national social responsibility infrastructure in place to prevent, minimise, and treat problem gambling as they would with any other consumptive and potentially addictive behaviour (e.g., drinking alcohol, smoking cigarettes, etc.)

Please note: A version of this article first appeared in Science and Technology (Pan European Networks) magazine (Volume 15, pages 153-155).

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

Further reading

Griffiths, M.D. (2003). Internet gambling: Issues, concerns and recommendations. CyberPsychology and Behavior, 6, 557-568.

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

Griffiths, M.D. (2011). Gaming convergence: Further legal issues and psychosocial impact. Gaming Law Review and Economics, 14, 461-464.

Griffiths, M.D. (2012). Mind games (A brief psychosocial overview of in-play betting). i-Gaming Business Affiliate, June/July, 44.

Griffiths, M.D. (2012). Internet gambling, player protection and social responsibility. In R. Williams, R. Wood & J. Parke (Ed.), Routledge Handbook of Internet Gambling (pp.227-249). London: Routledge.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2014). The technological convergence of gambling and gaming practices. In Richard, D.C.S., Blaszczynski, A. & Nower, L. (Eds.). The Wiley-Blackwell Handbook of Disordered Gambling (pp. 327-346). Chichester: Wiley.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? (pp. 277-292). New York: Prometheus Books.

Kuss, D.J. & Griffiths, M.D. (2012).  Internet gambling behavior. In Z. Yan (Ed.), Encyclopedia of Cyber Behavior (pp.735-753). Pennsylvania: IGI Global.

McCormack, A. & Griffiths, M.D. (2013). A scoping study of the structural and situational characteristics of internet gambling. International Journal of Cyber Behavior, Psychology and Learning, 3(1), 29-49.

Meyer, G., Hayer, T. & Griffiths, M.D. (2009). Problem Gaming in Europe: Challenges, Prevention, and Interventions. New York: Springer.

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

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

Zangeneh, M., Griffiths, M.D. & Parke, J. (2008). The marketing of gambling. In Zangeneh, M., Blaszczynski, A., and Turner, N. (Eds.), In The Pursuit Of Winning (pp. 135-153). New York: Springer.

Ringing the changes: Can disordered mobile phone use be considered a behavioural addiction?

Over the last decade, I have published various papers on excessive mobile phone use both in general and related to particular aspects of mobile phone use (such as gambling and gaming via mobile phones (see ‘Further reading’ below). Recently, some colleagues and I (and led by Dr. Joël Billieux) published a new review in the journal Current Addiction Reports examining disordered mobile phone use.

I don’t think many people would say that their lives are worse because of mobile phones as the positives appear to greatly outweigh the negatives. However, in the scientific literature, excessive mobile phone use has been linked with self-reported dependence and addiction-like symptoms, sleep interference, financial problems, dangerous use (phoning while driving), prohibited use (phoning in banned areas), and mobile phone-based aggressive behaviours (e.g., cyberbullying).

Despite accumulating evidence that mobile phone use can become problematic and lead to negative consequences, its incidence, prevalence, and symptomatology remain a matter of much debate. For instance, our recent review noted that prevalence studies conducted within the last decade have reported highly variable rates of problematic use ranging from just above 0% to more than 35%. This is mainly due to the fact most studies in the field have been conducted in the absence of a theoretical rationale.

Too often, excessive mobile phone use has simply been conceptualized as a behavioural addiction and subsequently develop screening tools using items adapted from the substance use and pathological gambling literature, without taking into account either the specificities of mobile phone “addiction” (e.g., dysfunctional mobile phone use may often be related to interpersonal processes) or the fact that the most recent generation of mobile phones (i.e., smartphones) are tools that – like the internet – allow the involvement in a wide range of activities going far beyond traditional oral and written (SMS) communication between individuals (e.g., gaming, gambling, social networking, shopping, etc.).

The first scientific studies examining problematic mobile phone use (PMPU) were published a decade ago. Since then, the number of published studies on the topic has grown substantially. At present, several terms are frequently used to describe the phenomenon, the more popular being ‘mobile phone (or smartphone) addiction’, ‘mobile phone (or smartphone) dependence’ or ‘nomophobia’ (that refers to the fear of not being able to use the mobile phone).

PMPU is generally conceptualized as a behavioural addiction including the core components of addictive behaviours, such as cognitive salience, loss of control, mood modification, tolerance, withdrawal, conflict and relapse. Accordingly, the criteria (and screening tools developed using such criteria) that have been proposed to diagnose an addiction to the mobile phone have been directly transposed from those classifying and diagnosing other addictive behaviours, i.e., the criteria for substance use and pathological gambling. For example, in a recent study published in the Journal of Behavioral Addictions, Dr. Peter Smetaniuk reported a prevalence of PMPU around 20% in U.S. undergraduate students using adapted survey items that were initially developed to diagnose disordered gambling.

Although many scholars believe that PMPU is a behavioural addiction, evidence is still lacking that either confirms or rejects such conceptualization. Indeed, the fact that this condition can be considered as an addiction is to date only supported by exploratory studies relying on self-report data collected via convenience samples. More specifically, there is a crucial lack of evidence that similar neurobiological and psychological mechanisms are involved in the aetiology of mobile phone addiction compared to other chemical and behavioural addictions. Such types of evidence played a major role in the recent recognition of Gambling Disorder and Internet Gaming Disorder as addictive disorders in the latest (fifth) addiction of the DSM (i.e., DSM-5) In particular, three key features of addictive behaviours, namely loss of control, tolerance and withdrawal, have – to date – received very limited empirical support in the field of mobile phone addiction research.

Given these concerns, it appears that the empirical evidence supporting the conceptualization of PMPU as a genuine addictive behaviour is currently scarce. However, this does not mean that PMPU is not a genuine addictive behaviour (at least for a subgroup of individuals displaying PMPU symptoms), but rather that the nature and amount of the available data at the present time are not sufficient to draw definitive and valid conclusions. Therefore, further studies are required. In particular, longitudinal and experimental research is needed to obtain behavioural and neurobiological correlates of PMPU. In the absence of such types of data, all attempts to consider PMPU within the framework of behavioural addictions will remain tentative. It is worth noting here that it took decades of empirical research before disordered gambling was officially recognized as an addiction (as opposed to a disorder of impulse control) in the DSM-5.

The current conceptual chaos surrounding PMPU research can also be related to the fact that while the number of empirical studies is growing quickly, these studies have (to date) primarily been based on concepts borrowed from other disorders (e.g., problematic Internet use, pathological gambling, substance abuse, etc.). This approach is atheoretical and lacks specificity with regard to the phenomenon under investigation. In fact, by adopting such a ‘confirmatory approach’ relying on deductive quantitative studies, important findings that are unique to the experience of PMPU have been neglected. As an illustration, no qualitative analyses of PMPU exist, and only a few models have been proposed. This implies that most studies have been conducted without a theoretical rationale that goes beyond transposing what is known about addictions in the analysis of PMPU.

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

Additional input: Joël Billieux, Pierre Maurage, Olatz Lopez-Fernandez and Daria J. Kuss

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 behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

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. (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.

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. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

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

Needles and the damage done: A brief look at ‘knitting addiction’

In a previous blog, I briefly looked at ‘quilting addiction’. It was while I was researching that blog that I also came across a number of academic papers on the sociology of knitting and various references in the academic (and non-academic) literature to ‘knitting addiction’. In previous blogs I have written about the work of Dr. Bill Glasser who introduced the concept of ‘positive addiction’ in a 1976 book of the same name.

In a more recent 2012 paper on the topic in the Canadian Journal of Counselling and Psychotherapy, Glasser claimed that he had heard numerous stories from many different individuals claiming they were ‘positively addicted “to a variety of activities such as swimming, hiking, bike riding, yoga, Zen, knitting, crocheting, hunting, fishing, skiing, rowing, playing a musical instrument, singing, dancing, and many more”. Glasser (1976) argued that activities such as jogging and transcendental meditation were positive addictions and were the kinds of activity that could be deliberately cultivated to wean addicts away from more harmful and sinister preoccupations. He also asserted that positive addictions must be new rewarding activities that produce increased feelings of self-efficacy.

This idea has actually been put into practice with knitting. Dr. Kathryn Duffy published a paper in a 2007 issue of the Journal of Groups in Addiction and Recovery about knitting as an experiential teaching method for affect management for females in addiction group therapy at a drug and alcohol rehabilitation centre. Duffy claimed her knitting program had been successful in facilitating discussions and beneficial in providing a skill for moderating stress and emotions, both for female inpatient and outpatient drug and alcohol addicts.

A more recent paper by Dr. Betsan Corkhill and colleagues examined knitting and wellbeing (in a 2014 issue of Textile: The Journal of Cloth and Culture), using the World Health Organisation’s definition of wellbeing as “an ability to realize personal potential, cope with daily stresses, and contribute productively to society”. Their paper argued that knitting contributes to human wellbeing and has therapeutic benefits for those that engage in it because it is a behaviour (like many others) that can be used as a coping mechanism that can help overcome the daily pressures of life. One of the more interesting papers that I read on knitting was one published in a 2011 issue of Utopian Studies by Dr. Jack Bratich and Dr. Heidi Brush about “fabriculture” and “craftivism”:

“When we speak of ‘fabriculture’ or craft culture, we are referring to a whole range of practices usually defined as the ‘domestic arts’: knitting, crocheting, scrapbooking, quilting, embroidery, sewing, doll-making. More than the actual handicraft, we are referring to the recent popularization and resurgence of interest in these crafts, especially among young women. We are taking into account the mainstream forms found in Martha Stewart Living as well as the more explicitly activist (or craftivist) versions such as Cast Off, Anarchist Knitting Circle, MicroRevolt, Anarchist Knitting Mob, Revolutionary Knitting Circle, and Craftivism…When we use the term craft-work, we are specifically referring to the laboring practices involved in crafting, while fabriculture speaks to the broader practices (meaning-making, communicative, community-building) intertwined with this (im)material labor”.

The paper also outlined how women who knit in public (such as during a lecture or a conference) are often castigated and/or ridiculed for their behaviour. They even cited Sigmund Freud in relation to why knitting in public causes discomfort for onlookers:

“Freud institutionalized a concept denoting the jarring and disorienting effect of being spatially out of phase: unheimlich. The queasiness of the unheimlich occurs also when interiors become exteriorized (especially the home, as it also means unhomely). Knitting in public turns the interiority of the domestic outward, exposing that which exists within enclosures, through invisibility and through unpaid labor: the production of home life. Knitting in public also inevitably makes this question of space an explicitly gendered one. One commentator observes that knitting in public today is analogous to the outcry against breast-feeding in public twenty years ago (Higgins 2005). Both acts rip open the enclosure of the domestic space to public consumption. Both acts are also intensely productive and have generally contributed to women’s heretofore invisible and unpaid labor. But could such an innocuous activity as knitting have such social ramifications? How disruptive can fabriculture be when crafting women are more in the public eye than ever before? Many of us may know that Julia Roberts, Gwyneth Paltrow, Madonna, and other celebs knit”.

The paper goes on to say that there are various knitting blogs (such as Etherknitter) that “expose the dark side of knitting” including excessive consumption and addiction. I then went onto the Etherknitter website and located an article specifically written on knitting addiction (‘Etherknitter’ turned out to be the pseudonym of the individual that runs the site). Here are some extracts from the article which also notes some of the shared terminology between drug addiction and knitting addiction:

“It’s been a revealing several days. I have discovered that I am incapable of not knitting. The only thing that would have stopped me would have been pain… In college, when I flirted with smoking cigarettes for six weeks…Alcohol has never appealed…In my profession, an uncomfortable number of practitioners succumb to the siren song of drug addiction…Then we get to knitting. I can’t not knit. Well, I can, but it hurts too much to be worth it. (I wonder if that’s why addicts stay addicted.) I was talking to a [fabric store] owner recently…She commented that the staff in the store sees a lot of people at the store who act out their neediness through yarn. She saw it as uncontrolled buying. Since we were talking about obesity in America at the time, she was tying it into alcohol/drug and food addiction. [The Too Much Wool website] pointed out our knitterly use of the word ‘stash’, and its clear crossover to the drug culture. Blogworld is full of knitters describing uncontrolled stash acquistions [such as ‘majorknitter’]. And trying to hide the size of the stash from significant others. And selling parts of their stash to others. The addiction to fiber and knitting is probably more benign, except for the financial aspects, and the time constraints. I really do have to beat myself to fulfill the more boring paperwork obligations in my life since I started knitting. The needles (aha! Another crossover analogy) are more fun. I don’t plan to do anything about my knit-addiction quite yet. But it does bother me”. 

In researching this article I came across a number of online accounts of people claiming to be genuinely addicted to knitting. This extract was particularly revealing as this short account seems to highlight many of the core components of addiction such as salience, conflict, and withdrawal symptoms:

“So, I’m 22 and I go through all that typical 22-year old stuff. Sometimes, my life gets rough and I have trouble coping. Rather than going out with friends and drinking till I puke, or going and smoking a few cigarettes or a joint, or having sex with random boys, I turn to my knitting in times of crisis. This might sound like a constructive thing. After all, I’m creating rather than destroying, right? Wrong. I say that I’m addicted because I am. I can’t function on a normal level without my knitting bag at my side. I can’t sit still in class or on a break if I’m not knitting. My head hurts, I sweat, I get jittery if my hands are doing nothing. And it gets worse. I skip classes to go to yarn stores. I come back late from breaks at work because I needed to finish just one more row. I already have one knitting tattoo and another planned. I pay my rent late because I spent my entire paycheck on yarn. My boyfriend’s half of the apartment is slowly being taken over by my stash. My life isn’t complete without knitting. I bought two spinning wheels so I could spin my own yarn. I think that if I ever lost a hand or arm due to an accident I would probably kill myself because I couldn’t knit…I’ve admitted to myself that I have a problem, but most people see knitting as simply my hobby. It goes so much deeper than that and I feel like I finally needed to say something”.

Academically, there is little on knitting addiction. In an unpublished thesis by Christiana Croghan, she noted in one paragraph that:

“Baird (2009) supports the theory that knitting alters brain chemistry, lowering stress hormones and boosting the production of serotonin and dopamine. Dittrich (2001) argues while there are many health benefits associated with knitting there is also a health risk of the possible development of carpal tunnel syndrome. Research suggests knitting may also have an addictive quality that Corkhill (2008) considers to be a constructive addiction that may replace other more severe harmful addictions. Marer (2002) interviewed professional women who knit during lunch hours, and found a consistent theme of relief from anxiety and a sense of clear headedness at work. Marer (2002) also found patients with severe illnesses such as cancer experience a greater sense of coping when they knit”.

More specifically on addiction, a 2011 issue of Asian Culture and History, Hye Young Shin and Dr. Ji Soo Ha examined knitting practice in Korea. Their qualitative research revealed that:

“Immersion in knitting projects can become so intense as to create anxiety for some knitters after the completion of a knitting project. They confess a sense of emptiness or feeling lost after a period of deep mental and physical engagement. This suggests that knitting can become an activity that does not arise out of necessity or has a clear purpose. However, knitters who have a lot of experience with knitting practice tend to say that long experience with knitting has enabled them to handle this urge to indulge in knitting, a typical symptom in the early stage of one’s knitting career”.

Their paper includes the following quotes from knitters that they interviewed:

• Extract 1: “Knitting is a kind of addiction or drug. I feel so bored and empty and a sense of being lost when I’m done with one project.”
• Extract 2: “For example, I check the time when a TV drama begins and I can stop knitting when the drama starts. When I first started knitting, I couldn’t control my urge to keep knitting on and on, but now I can; otherwise I can’t enjoy it as a pleasurable and long-term hobby. I still want to carry on when I sit for knitting, not wanting to stand up to wash the dishes, but now I can control myself.”

I have always argued that is theoretically possible for an individual to become addicted to anything if there are constant reinforcements (i.e., rewards). The anecdotal reports in this article suggest that a few individuals appear to experience addiction-like symptoms but there is too little detail to say one way or another whether knitting addiction genuinely exists.

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

Further reading

Baird, M., (2009). Fighting the stress with knitting needles. Located at: http://heal-all.org/art/18/human-body/1999/fighting-the-stress-with-knitting-needles

Bratich, J. Z., & Brush, H. M. (2011). Fabricating activism: Craft-work, popular culture, gender. Utopian Studies, 22(2), 233-260.

Corkhill, B. (2008) Therapeutic knitting. retrieved from www.knitonthenet.com/issue4/features/therapeutic knitting/

Corkhill, B., Hemmings, J., Maddock, A., & Riley, J. (2014). Knitting and Well-being. Textile: The Journal of Cloth and Culture, 12(1), 34-57.

Croghan, C. (2013). Knitting is the new yoga? Comparing techniques; physiological and psychological indicators of the relaxation response. Unpublished manuscript. Located at: http://esource.dbs.ie/handle/10788/1586

Dittrich, L. R. (2001) Knitting. Academic Medicine, 76(7), 671. Retrieved from: http://knittingbrain.com/results.php

Duffy, K. (2007). Knitting through recovery one stitch at a time: Knitting as an experiential teaching method for affect management in group therapy. Journal of Groups in Addiction and Recovery, 2(1), 67-83.

Glasser, W. (1976), Positive Addictions. New York, NY: Harper & Row.

Glasser, W. (2012). Promoting client strength through positive addiction. Canadian Journal of Counselling and Psychotherapy, 11(4), 173-175.

Etherknitter (2006). Public displays of knitting. Etherknitter Blog. Accessed April 19, 2006, http://etherknitter.typepad.com/etherknitter/2006/03/please_picture_.html

Marer, E. (2002). Knitting: the new yoga. Health, 16(2), 76-78.

Shin, H. Y., & Ha, J. S. (2011). Knitting practice in Korea: A geography of everyday experiences. Asian Culture and History, 3(1), 105-114.

Meditate to medicate: Mindfulness as a treatment for behavioural addiction

Please note: A version of the following article was first published on addiction.com and was co-written with my research colleagues Edo Shonin and William Van Gordon

Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, 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.

Throughout the last two decades, Buddhist principles have increasingly been employed in the treatment of a wide range of psychological disorders including mood and anxiety disorders, substance use disorders, bipolar disorder, and schizophrenia-spectrum disorders. The emerging role of Buddhism in clinical settings appears to mirror a growth in research examining the potential effects of Buddhist meditation on brain neurophysiology. Such research forms part of a wider dialogue concerned with the evidence-based applications of specific forms of spiritual practice for improved psychological health.

Within mental health and addiction treatment settings, mindfulness-based interventions (MBIs) are generally delivered in a secular eight-week format and often comprise the following: (i) weekly sessions of 90-180 minutes duration, (ii) a taught psycho-education component, (iii) guided mindfulness exercises, (iv) a CD of guided meditation to facilitate daily self-practice, and (v) varying degrees of one-to-one discussion-based therapy with the program instructor. Examples of MBIs used in behavioural addiction treatment studies include Mindfulness-Based Cognitive Therapy, Mindfulness-Enhanced Cognitive Behaviour Therapy, Mindfulness-Based Relapse Prevention, Mindfulness-Based Stress Reduction, and Meditation Awareness Training.

Studies investigating the role of mindfulness in the treatment of behavioural addictions have – to date – primarily focused on problem and/or pathological gambling. These studies have shown that levels of dispositional mindfulness in problem gamblers are inversely associated with gambling severity, thought suppression, and psychological distress. Recent clinical case studies have demonstrated that weekly mindfulness therapy sessions can lead to clinically significant change in problem gambling individuals. Published case studies include: (i) a male in his sixties addicted to offline roulette playing, (ii) a 61-year old female (with comorbid anxiety and depression) addicted to slot machine gambling (treated with a modified version of Mindfulness-Based Cognitive Therapy), and (iii) a 32-year old female (with co-occurring schizophrenia) addicted to online slot-machine playing (treated with a modified version of Meditation Awareness Training). Also, a recent study showed that problem gamblers that received Mindfulness-Enhanced Cognitive Behaviour Therapy demonstrated significant improvements compared to a control group in levels of gambling severity, gambling urges, and emotional distress.

Outside of gambling addiction, case studies have investigated the applications of mindfulness for treating addiction to work (i.e., workaholism) and sex. In the case of the workaholic, a director of a blue-chip technology company in his late thirties was successfully treated for his workaholism utilizing Meditation Awareness Training. Significant pre-post improvements were also observed for sleep quality, psychological distress, work duration, work involvement during non-work hours, and employer-rated job performance. However, as with any case study, the single-participant nature of the study significantly restricts the generalizability of such findings.

Key treatment mechanisms that have been identified and/or proposed in this respect (several of which overlap with mechanisms identified as part of the mindfulness-based treatment of chemical addictions) include:

• A perceptual shift in the mode of responding and relating to sensory and cognitive-affective stimuli that permits individuals to objectify their cognitive processes and to apprehend them as passing phenomena.
• Reductions in relapse and withdrawal symptoms via substituting maladaptive addictive behaviours with a ‘positive addiction’ to mindfulness/meditation (particularly the ‘blissful’ and/or tranquil states associated with certain meditative practices).
• Transferring the locus of control for stress from external conditions to internal metacognitive and attentional resources.
• The modulation of dysphoric mood states and addiction-related shameful and self-disparaging schemas via the cultivation of compassion and self-compassion.
• Reductions in salience and myopic focus on reward (i.e., by undermining the intrinsic value and ‘authenticity’ that individuals assign to the object of addiction) due to a better understanding of the ‘impermanent’ nature of existence (e.g., all that is won must ultimately be lost, an attractive body will age and wither, a senior/lucrative occupational role must one day be relinquished, etc.).
• Growth in spiritual awareness that broadens perspective and induces a re-evaluation of life priorities.
• ‘Urge surfing’ (the meditative process of adopting an observatory, non-judgemental, and non-reactive attentional-set towards mental urges) that aids in the regulation of habitual compulsive responses.
• Reduced autonomic and psychological arousal via conscious-breathing-induced increases in prefrontal functioning and vagal nerve output (breath awareness is a central feature of mindfulness practice).
• Increased capacity to defer gratitude due to improvements in levels of patience.
• A greater ability to label and therefore modulate mental urges and faulty thinking patterns.

Although preliminary findings indicate that there are applications for MBIs in the treatment of behavioural addictions, further empirical and clinical research utilizing larger-sample controlled study designs is clearly needed. Despite this, both the classical Buddhist meditation literature and recent scientific findings appear to agree that when correctly practised and administered, mindfulness meditation is a safe, non-invasive, and cost-effective tool for treating behavioural addictions and for improving psychological health more generally.

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

Further reading

Griffiths, M.D., Shonin, E.S., & Van Gordon, W. (2015). Mindfulness as a treatment for gambling disorder. Journal of Gambling and Commercial Gaming Research, in press.

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., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research and Therapy, 5: e122. doi: 10.4172/2155-6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Current trends in mindfulness and mental health. International Journal of Mental Health and Addiction, 12, 113-115.

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. (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). 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. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

Shonin, E., Van Gordon W., Griffiths M.D. & Singh, N. (2015). There is only one mindfulness: Why science and Buddhism need to work together. Mindfulness, 6, 49-56.

Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone 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.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

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. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

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., 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.

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

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. & 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.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

It’s no fabrication: A brief look at ‘quilting addiction’

“I am addicted to quilting enjoying the color, texture and patterns. This [Pinterest] board inspires me in color, quilts, designs and quilting!” (Kim Hazlett)

“My name is Laura and I’m addicted to quilting. I know there could be worse addictions, so all things considered, quilting is a harmless addiction. Unless that is, you are running out of time to do it all!. I did 4 [square blocks] over the past week and a half. I jumped ahead. I couldn’t help it. The more I make, the more I want to keep on making them! At this rate I’ll surely have all 111 blocks finished by 2012. Not that there’s a deadline)” (Laura)

“Addiction to quilting? Are you being serious?” I hear you say. Obviously there is no scientific research on ‘quilting addiction’ (although there is academic research on quilting that I’ll talk about later in this article) but a quick Google search shows there are numerous websites devoted to the topic (for example, Addicted to Quilts, My Quilting Addiction, Sew Addicted To Quilting, My Quilt Place, Quilt Addicts Anonymous, Addicted to Fabric, etc.). None of these sites are really about addiction but more about people’s overwhelming love of quilting (either professionally or personally). There are even books on the topic such as Get Addicted To Free-Motion Quilting (by Sheila Sinclair Snyder) and dedicated webpages such as ‘Addicted To Scraps’ on the Quiltmaker website or ’15 reasons to get addicted to Kantha quilts’ on the Houzz website.

Renelda Peldunas-Harter (RPH), author of From Ensign’s Bars to Colonel’s Stars: Making Quilts to Honor Those Who Serve and author of the online article ‘Are you addicted to quilting?’ asserted:

“Quilting is habit-forming and I’m going to try and break down certain aspects of the addiction. I’m going to throw a disclaimer in right here – I am not trained to diagnose or explain anything, I am merely an observer and chronicler of the quilting animal and want to share my observations. Quilters can display many ‘habit-forming’ behaviors”.

RPH breaks quilting into three categories – the fabrics, the tools used, and stash building (more of which later in the blog). More specifically, quilting addiction depends upon the type of fabrics chosen to make quilts, the number of different tools the quilter owns to make quilts, and (probably the most obvious indicators of an addiction) the accumulating of quilting paraphernalia. For RPH, stash building encompasses many things:

“It can mean an obsession to make quilt related gifts, compulsion to collect quilt magazines, quilt gadgets, quilt patterns, fabric/items with a certain theme, machines, patterns, or buying large/medium/small amounts of fabric in general with no earthly idea of what to do with it – otherwise known as stash building!”

With tongue firmly in cheek, the article outlines ‘The Quilting Commandments, which if adhered to could certainly indicative of addiction: “(1) Always buy new fabric no matter how much you already have; (2) Sew all day and night – absolutely no cooking permitted; (3) Always start a new quilt before the last one is finished; (4) Repeat Step 1”.

While researching this article, I was surprised to find that there had been quite a bit of research on quilting. In a 2001 paper in the World Leisure Journal, Dr. Faye King examined the social dynamics of quilting (based on her own 1997 PhD thesis). Based on her research, Faye reached three main conclusions: (i) quilting expresses powerful rhetorical statements about the maker’s values and social concerns (in which Faye provides a number of examples of where quilts were created to make political statements); (ii) quilting can have a social impact on society as well as their individual maker (those donated to charities and hospitals for sick children); and (iii) quilting provides meaning for the maker and as a leisure activity can help help reduce stress in one’s life (which indirectly provides a reason as to why some people might theoretically develop an ‘addiction’).

A qualitative study by Dr. Rhiannon Gainor of 25 quilters that run their own quilting websites and/or blogs examined motivations for quilting and their expressions of personal creativity. One of the salient themes that emerged was ‘quilting as passion’ and described by some as an addiction. More specifically, Gainor noted that:

“Quilters also wrote about quilting being a passion, an addiction, and a lifelong interest. These kinds of comments on the sites made it clear that quilting for many is more avocation than pastime, supporting Stebbins’ (2004) definition of the serious leisure enthusiast as one finding gratification and fulfillment, rather than mere fun, in their chosen activity”.

Dr. Marybeth Stalp has written a few papers on quilting. In one of them published in a 2008 issue of the journal Home Cultures, she examined the “stash” of those that engaged in domestic handicraft (including quilters). She makes a reference to addiction:

“Those who create domestic arts and handcrafts are quite familiar with the term ‘stash’ and may even have one (or more). While it is not a reference to addictive drugs (or is it?), questions regarding the stash illuminate the themes that exist within the stash and the ‘lifeworlds’ of the collectors of the stash”.

Via participant observation and interviews, the paper examined the meaning and role of the stash in the lives of knitters, quilters, and crocheters. Arguably, the findings use the language of addictions in various places:

“Handcrafters collectively refer to their collections as ‘stash,’ hoard whatever they collect over time, find un/official support groups to support their habits, and together strategize hiding places and storage. Collecting, hoarding, and hiding stash is quite normal for crafters, yet such acts are often deviant to others, particularly those who share their living space. Often the stash is portrayed negatively by non-crafting family members and friends, as well as the popular media, and sometimes even by handcrafters themselves…The handcrafter continues to acquire and stash fabric, yarn, floss, etc. despite how much space the stash demands, or how the stash influences relationships with others. The larger social structures of family, work and friends shape how we think about our stashes”.

In an earlier paper published in a 2006 issue of the journal Textile: The Journal of Cloth and Culture, Stalp presented her results of a four-year ethnographic study of 70 US amateur quilters. She examined the “guilty pleasures surrounding quilting practices, including the deviant acts of hiding both identity and fabric from family members and friends”. The paper describes how quilters slowly build up their stash of fabric, purchasing more fabric than they need than necessary, and both hoarding and strategically hiding it from their families. She then goes on to say that:

“Women’s anxieties surrounding acquiring, hoarding, and hiding their fabric stashes highlight their diminished ability, relative to their spouses and their children, to pursue leisure activities without a stigma. Collecting and hiding the fabric stash become symbolic of women’s attempts to carve out time and space for themselves amid the multiple demands placed on them by such greedy institutions such as family and the workplace”. 

Another academic who has written a few papers on quilting is Dr. Rosemary Wilkinson. Her first paper on the topic in the International Journal of the Humanities examined the rhetoric of obsession, addiction, guilt, and subterfuge in two Australian quilters’ magazines (Down Under Quilts and Quilters Companion) over a five-year period. She reported that while some of the quilting publications describe the benefits of quilting to individuals and communities, she also noted the ways in which the magazines integrate the “rhetotic of addiction” in constructing of the identity of quilters. She concludes that:

“[This] ploy seemingly at odds with the overall positive and promotional tone of the magazines…[the findings] demonstrate that the concept of addiction is exploited within the magazines to reinforce the quilter’s creative drive, her communal belonging and her vocation”.

In a more recent 2014 paper in the journal TEXT, Dr. Williamson reprised the same findings:

“Both the turning towards and the intensity of commitment to quilts may be expressed through metaphors of addiction, illness or affliction. The rhetoric of addiction is well established among quilters generally, and has occurred in [Australian quilting magazines] since their inception…Profiles from 2010 to 2013 contain references to, for example, catching ‘the quilting bug’…or other phrases that translate commitment into popular clichés of addiction (‘Jenny began a creative journey that soon became an addiction, as is so often the case’)…Frequent references in profiles to quilters’ passion for what they do, even if expressed in clichés of addiction, connote personal commitment and satisfaction as driving forces for career development that is organic and responsive to, and accommodating of, personal circumstances”.

In reading the academic papers on quilting, I got the sense that the word ‘addiction’ was being used in a non-clinical sense and as a metaphor for justifying the amount of time that quilters engaged in their passion and pastime. There was little evidence of negative detriment although some quilters clearly feel they need to lie about or hide away aspects of their hobby.

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

Further reading

Bratich, J. Z., & Brush, H. M. (2011). Fabricating activism: Craft-work, popular culture, gender. Utopian Studies, 22(2), 233-260.

Gainor, R. (2011). Hobby quilting websites and voluntary provision of information. New Directions in Folklore, 9(1/2), 41-67.

King, F.L. (2001). Social dynamics of quilting. World Leisure Journal, 43(2), 26-29.

Peldunas-Harter, R. (2014). Are you addicted to quilting? Take the quiz. Schiffer Publishing, December 15. Located at: http://schifferpublishing.tumblr.com/post/105289542106/are-you-addicted-to-quilting-take-the-quiz

Sayasane, J.H. (2011). My quilting addiction explained. Quilters Newsletter, March 2. Located at: http://www.quiltersnewsletter.com/blogs/insideqn/2011/03/02/my-quilting-addiction-explained/

Stalp, M. C. (2006). Hiding the (fabric) stash: Collecting, hoarding, and hiding strategies of contemporary US quilters. Textile: The Journal of Cloth and Culture, 4(1), 104-124.

Stalp, M. C., & Winge, T. M. (2008). My collection is bigger than yours: Tales from the handcrafter’s stash. Home Cultures, 5(2), 197-218.

Stebbins, R. (2007). Serious Leisure: A Perspective for Our Time. New Brunswick, NJ: Transaction Publishers.

Williamson, R. (2008). Obsession, guilt, subterfuge and penury: The rhetoric of addiction and the construction of creative identity in Australian quilters’ magazines. The International Journal of the Humanities, 5(11), 163-70.

Williamson, R. (2014). Modelling the creative and professional self: The magazine profile as narrative of transition and transformation. TEXT, Special Issue 25. Australasian magazines: new perspectives on writing and publishing. http://www.textjournal.com.au/speciss/issue25/Williamson.pdf

The must of lust discussed: Why isn’t sex addiction in the DSM-5?

Please note: A shorter and slightly different version of this blog first appeared on addiction.com

Sex addiction appears to be a highly controversial area among both the general public and those who work in the addiction field. Some psychologists adhere to the position that unless the behaviour involves the ingestion of a psychoactive substance (e.g., alcohol, nicotine, cocaine heroin), then it can’t really be considered an addiction. But I’m not one of them. If it were up to me, I would have given serious consideration to including sex addiction in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Given that ‘gambling disorder’ was reclassified from a disorder of impulse control to a behavioural addiction in the DSM-5, there is now no theoretical reason why other behavioural addictions can’t be added in the years to come. So why wasn’t sex addiction included in the latest DSM-5? Here are some possible reasons.

Some researchers think that sex addiction just doesn’t exist (for moral and theoretical reasons): Many scholars have attacked the whole concept of sex addiction saying it is a complete myth. It’s not hard to see why, as many of the claims appear to have good face validity. Many sociologists would argue that ‘sex addiction’ is little more than a label for sexual behaviour that significantly deviates from society’s norms. The most conventional attack on sex addiction is a variation on the position outlined in my introduction (i.e., that ‘addiction’ is a physiological condition caused by ingestion of physiological substances, and must therefore be defined physiologically). There are also attacks on more moral grounds with people saying that if excessive sexual behaviour is classed as an addiction it undermines individuals’ responsibility for their behaviour (although this argument could be said of almost any addiction).

The word ‘addiction’ has become meaningless: There are also those researchers within the social sciences who claim that the every day use of the word ‘addiction’ has rendered the term meaningless (such as people saying that their favorite television show is ‘addictive viewing’ or that certain books are ‘addictive reading’). Related to this is that those that work in the field don’t agree on what the disorder (e.g. ‘sex addiction’, ‘sexual addiction’, ‘hypersexuality disorder’, ‘compulsive sexual behaviour’, ‘pornography addiction’, etc.) should be called and whether it is a syndrome (i.e., a group of symptoms that consistently occur together, or a condition characterized by a set of associated symptoms) or whether there are many different sub-types (pathological promiscuity, compulsive masturbation, etc.). 

There is a lack of empirical evidence about sex addiction: One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak. Although there has been a lot of research, there has never been any nationally representative prevalence surveys of sex addiction using validated addiction criteria, and a lot of research studies are based upon those people who turn up for treatment. Like Internet Gaming Disorder (which is now in the appendix of the DSM-5), sex addiction (or more likely ‘Hypersexual Disorder’) will not be included as a separate mental disorder until the (i) defining features of sex addiction have been identified, (ii) reliability and validity of specific sex addiction criteria have been obtained cross-culturally, (iii) prevalence rates of sex addiction have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features of sex addiction have been evaluated.

The term ‘sex addiction’ is used an excuse to justify infidelity: One of the reasons why sex addiction may not be taken seriously is that the term is often used by high profile celebrities as an excuse by those individuals who have been sexually unfaithful to their partners (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand). In some of these cases, sex addiction is used to justify the individual’s serial infidelity. This is what social psychologists refer to as a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they were bombarded with sexual advances from other individuals and succumbed. But how many people wouldn’t do the same thing if they had the opportunity? It becomes a problem only when you’re discovered, when it’s in danger of harming the celebrity’s brand image.

The evidence for sex addiction is inflated by those with a vested interest: One of the real issues in the field of sex addiction is that we really have no idea of how many people genuinely experience sex addiction. Sex addiction specialists like Patrick Carnes claims that up to 6% of all adults are addicted to sex. If this was really the case I would expect there to be sex addiction clinics and self-help support groups in every major city across the world – but that isn’t the case. However, that doesn’t mean sex addiction doesn’t exist, only that the size of the problem isn’t on the scale that Carnes suggests. Coupled with this is that those therapists that treat sex addiction have a vested interest. Out simply, there are many therapists worldwide who make a living out of treating the disorder. Getting the disorder recognized by leading psychological and psychiatric organizations (e.g., American Psychiatric Association, World Health Organization) legitimizes the work of sex addiction counselors and therapists so it is not surprising when such individuals claim how widespread the disorder is.

There may of course be other reasons why sex addiction is not considered a genuine disorder. Compared to behavioural addictions like gambling disorder, the empirical evidence base is weak. There is little in the way of neurobiological research (increasingly seen as ‘gold standard’ research when it comes to legitimizing addictions as genuine). But carrying out research on those who claim to have sex addiction can face ethical problems. For instance, is it ethical to show hardcore pornography to a self-admitted pornography addict while participating in a brain neuroimaging experiment? Is the viewing of such material likely to stimulate and enhance the individual’s sexual urges and result in a relapse following the experiment? There are also issues surrounding cultural norms. The normality and abnormality of sexual behaviour lies on a continuum but what is considered normal and appropriate in one culture may not be viewed similarly in another (what is often referred to by sociologists as ‘normative ambiguity’). Personally, I believe that sex addiction is a reality but that it affects a small minority of individuals. However, many sex therapists claim it is on the increase, particularly because the Internet has made sexual material so easy to access. Maybe if sex addiction does eventually make it into future editions of the DSM, it will be one of the sub-categories of Internet Addiction Disorder rather than a standalone category.

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

Further reading

Dhuffar, M. & Griffiths, M.D. (2014). Understanding the role of shame and its consequences in female hypersexual behaviours: A pilot study. Journal of Behavioural Addictions, 3, 231–237.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, DOI 10.1007/s40429-015-0055-x

Goodman, A. (1992). Sexual addiction: Designation and treatment. Journal of Sex and Marital Therapy, 18, 303-314.

Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2001). Addicted to love: The psychology of sex addiction. Psychology Review, 8, 20-23.

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

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.

Orford, J. (2001). Excessive sexuality. In J. Orford, Excessive Appetites: A Psychological View of the Addictions. Chichester: Wiley.

In dependence days: A brief overview of behavioural addictions

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

Griffiths, M.D. (2011). Workaholism: A 21^st 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.

Prophet share: A case study of ‘addiction to fortune telling’

In the latest issue of the Journal of Behavioral Addictions, there are two papers that I co-authored on muscle dysmorphia as an addiction (see ‘Further reading’ below). The reason I mention this is because in the same issue there was a case study report by Dr. Marie Grall-Bronnec and her colleagues of a woman (Helen) that was ‘addicted’ to fortune tellers. As noted in their paper:

“Clairvoyance consulting, also known as fortune teller consulting, is a behavior that may seem harmless, but can also become excessive. Fortune telling is defined as the practice of predicting information about a person’s life, using for example…astrology, cartomancy or crystallomancy”.

As I have noted in a number of my previous blogs, I subscribe to the view that if there are clinical criteria for addiction and a behaviour fulfils the criteria, it should be classed as an addiction (irrespective of the behaviour). This has led to accusations of me “watering down the concept of addiction” because such criteria have been applied to behaviours as diverse as gardening and chewing gum. According to the authors of the ‘fortune telling addiction’ paper:

“Helen is a 45-year-old woman who declares early on suffering from ‘a clairvoyance addiction’…She has no particular medical history, except for two major depression episodes after romantic breakups, and does not take any medication. She regularly sees a psychiatrist for support psychotherapy because of negative life events (sexual abuse and death in her family). She is divorced and does not have any children. Her career as a manager seems to fully satisfy her. She decides to seek treatment on account of her excessive financial expenditures due to the consultation of fortune tellers. Another motivation that explains her decision is her age. Indeed, she says she is entering a new phase in her life, after renouncing to the idea of becoming a mother one day”.

According to the paper, Helen had been consulting fortune tellers since she was 19 years old. She started using such people for educational and career advice as she claimed that she was poor at reaching important decisions herself and thought the life choices she made would be wrong. The authors noted that her first meeting with a clairvoyant was an event that gave her a feeling of reassurance. In her mid-twenties, her visits to clairvoyants escalated significantly and ended up “losing control of her use of fortune telling”. At that particular time, she was visiting clairvoyants to get relationship advice from them (e.g., “Does he really love me?” and “How long will our relationship last?”). Her current ‘addiction to clairvoyants’ dates back to her mid- to late-30s when she got divorced after the failure of her marriage:

“She repeatedly returned to fortune telling to reassure herself about the future of her relationship, and increasingly so as it deteriorated. The breakup worsened the disorder. Since her divorce, she consults fortune tellers – not always the same person – on the phone or online, in a compulsive way, more and more often (up to every day), for longer and longer periods of time (up to 8 hours a day) and spends each time more and more money (up to 200 euros per session). As she is never satisfied with the fortune tellers’ predictions, she will consult again very soon after the latest call or connection. Every choice she has to make, from the most trivial (going to the movies) to the most important (making relationship decisions), leads her to irrationally consult a fortune teller”

Before each consultation she said he got very excited at the prospect and that the experience relieved all of her psychological discomfort (at least in the short-term). However, not long after consultations she would feel incredibly guilty. The paper also reported that during consultations with the fortune tellers, she was totally convinced that they could see her future and that their predictions would come true. He authors went on to report:

“This excessive behavior gives her some kind of reassurance and allows her to make up for her lack of self-confidence. In that sense, the excessive behavior could be considered as an attempt at self-medication or as a way to cope with negative emotions. However, Helen knows that her belief in the fortune tellers’ ability to predict the future is completely irrational. This brings major adverse consequences, particularly in financial terms: despite a comfortable income, she is indebted. She also says having low self-esteem, due to her in- ability to resist her strong urge to consult fortune tellers, and due to her being isolated from the others because of the time spent consulting fortune tellers. Helen succeeds in limiting the consultation of fortune tellers during short periods of time, when her financial situation becomes too critical”.

The authors of the report also used different sets of addiction criteria to determine whether Helen was truly addicted to consulting clairvoyants. They also used my own six criteria (salience, mood modification, tolerance, withdrawal, conflict, and relapse). Here are the authors own description of the behaviour using my components model:

• Salience: “Consulting fortune tellers becomes the most important activity in Helen’s life and dominates her thinking (preoccupation and cognitive distortions), feelings (cravings) and behavior (she has progressively quit all her leisure activities, particularly going out with friends)”.
• Mood modification: “Helen says feeling excitement before each consultation, but also feels nervous tension and anxiety. This excessive behavior gives her some kind of reassurance and the excessive behavior could be considered as an attempt at self-medication or a way to cope with negative emotions”.
• Tolerance: “Over time, Helen has been feeling a growing need to consult fortune tellers, and the consultations have to last longer to obtain the same effect of relief”.
• Withdrawal: “When she attempts to resist the urge to consult or has to refrain from consulting fortune tellers (in the case of her financial situation being too critical, for example), she feels tense and nervous”.
• Conflict: “Helen knows that her use of fortune telling is problematic, and that it brings very negative consequences. However, she cannot refrain from consulting fortune tellers, leading to an intra-psychic conflict and guilt”.
• Relapse: “Over the years, Helen has made repeated efforts to reduce and stop this problematic behavior. Her clinical course is characterized by relapses and remissions”.

Based on the evidence presented, there is clear evidence that Helen’s behaviour was problematic. Whether it was genuinely addictive is debatable but the authors provided some evidence that (in this case at least) the behaviour appeared to include some addictive aspects. The authors conclude that in addition to individual risk factors, other situational and structural characteristics may have played a role in the development of problematic behaviour concerning Helen’s ‘addiction’:

“Regarding the risk factors related to the object of addiction (i.e. fortune telling use), one might mention, inter alia, the possibility to consult online, which guarantees anonymity. Furthermore, the Internet increases both accessibility and availability. Finally, the money spent during fortune telling sessions seems virtual, which makes it all the more easy to spend. Increased risks related to the Internet have already been described on gambling (Griffiths, Wardle, Orford, Sproston & Erens, 2009). Regarding socio-environmental risk factors, today’s society encourages the need for control and does not give way to uncertainty. In Helen’s case, all the conditions were met for the fortune telling use to become excessive, and we are tempted to conclude that it is an addictive-like phenomenon”.

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

Further reading

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.

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

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

Griffiths, M. (2005). A “components” model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191–197.

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

Griffiths, M., Wardle, H., Orford, J., Sproston, K. & Erens, B. (2009). Sociodemographic correlates of internet gambling: Findings from the 2007 British gambling prevalence survey. CyberPsychology and Behavior, 12, 199–202.

Hughes, M., Behanna, R. & Signorella, M. L. (2001). Perceived ac- curacy of fortune telling and belief in the paranormal. Journal of Social Psychology, 141(1), 159–160.

Shein, P. P., Li, Y. Y. & Huang, T. C. (2014). Relationship between scientific knowledge and fortune-telling. Public Understanding of Science, 23(7), 780–796.

Flying ‘high’: A brief look at ‘binge flying’ and ‘flying addiction’

As part of my job I do a lot of travel. It’s an occupational necessity. Last year alone I did over 20 work trips abroad that comprised over 50 flights (such as the six flights that I had to take to get to a conference in Uruguay and then back to the UK). One of my research colleagues at a conference in Taiwan jokingly accused me of being ‘addicted’ to flying. Nothing could be further from the truth. For me, flying is little more than a way to get from A to B. However, I have tried to turn my experiences into something more positive and have written a number of short articles providing tips about flying and travelling abroad for outlets such as the British Medical Journal and the PsyPAG Quarterly (see ‘Further Reading’ below).

However, there are a few papers in the academic literature that have proposed the idea of ‘binge flying’ and ‘flying addiction’ in the Annals of Tourism Research. One British research team (Drs. Scott Cohen, James Higham and Christina Cavaliere) have written various papers on flying, particularly the dilemma that many business travellers face in wanting to be ‘green’ and ‘eco-friendly’ but knowing that the amount of flying they are doing is contributing to climate change and leaving a ‘carbon footprint’.

One of the papers published by Cohen and his colleagues was entitled ‘Binge flying: Behavioural addiction and climate change’. In their introduction to the topic, the authors referenced my 1996 paper in the Journal of Workplace Learning on behavioural addictions to argue there was now evidence that many behaviours could be potentially addictive even without the ingestion of a psychoactive substance. They then went on to say:

“[Two] articles in the popular press have further implicated frequent tourist air travel as a practice that may constitute behavioural addiction (Hill, 2007; Rosenthal, 2010). In stark contrast to most behavioural addictions, which are characterised by severe negative consequences for individuals directly, the destructive outcome attributable to excessive flying is premised upon air travel’s growing contribution to global climate change. Both Burns and Bibbings (2009) and Randles and Mander (2009) cite Hill’s (2007) interview in ‘The Observer’ with ‘Rough Guides’ founder Mark Ellingham, who coins the term ‘binge flying’ in critiquing the public’s growing appetite for holidays accessed through air travel”.

They also used my 1996 paper to make a number of points to support their premise that excessive flying can be conceptualized as an addiction. More specifically, they noted:

“Griffiths (1996) notes that behavioural addictions may have ‘normative ambiguity’, in that moderate use is accepted but stigma can result from over-enactment of the behaviour, or compulsive consumption (Hirschman, 1992)…Even though addictions are typically conceptualised as purely negative, Griffiths (1996) distinguishes a number of possible addiction benefits that individuals may perceive, such as changes of mood and feelings of escape, positive experiences of pleasure, excitement, relaxation, disinhibition of behaviour and the activity as a source of identity and/or meaning in life…Not only does excessive tourist air travel meet this basic criterion of behavioural addiction where longer-term outlooks are sacrificed for immediate gratification, but tourist experiences also supply many of the psychological benefits that Griffiths (1996) uses to characterise sites of potential behavioural addiction. These include feelings of escape, heightened experiences of pleasure and excitement (a ‘buzz’ or ‘rush’), relaxation, disinhibition of behaviour and the activity as an arena for identity work and searching for meaning in life”.

To support their argument that flying can be an addiction, they assert there are three key characteristics that can be found in addictive behavior that can be applied to flying: (i) a drive or urge to engage in the behaviour, (ii) a denial of the harmful consequences of the behaviour, and (iii) a failure in attempts to modify the behaviour. As regular readers of my blog will know, I operationally define addictive behaviour as comprising six components (salience, mood modification, tolerance, withdrawal, conflict and relapse), and as such, flying would be unlikely to be classed as an addiction by my own criteria. The authors interviewed 30 participants as part of their research but little of the qualitative data presented made any reference to addiction or elements of addictive behaviour. They somehow concluded that:

“Continued movement in consumer discourses towards a mainstream negative perception of the practice of holiday frequent flying may eventually find tourism consumption the further subject of query as an addictive phenomenon. Frequent air travel may then join gambling, smoking, shopping, video games and Internet use, (Clark & Calleja, 2008), amongst others, as ‘pathologised’ sites of behavioural addiction that reflect society’s (re)positioning of certain types of behaviour as socially dysfunctional”.

The concept of ‘binge flying’ and ‘flying addiction’ were more recently critiqued by Dr. Martin Young and colleagues in a 2014 issue of the Annals of Tourism Research. Their view closely matches my own view (and they also cite my 1996 paper on behavioural addictions) when they asserted:

“We take issue with the application of a behavioural addiction framework in the context of consumption generally, and frequent flying specifically. We argue that while the conceptual lens of behavioural addiction may be seductive to some (cf. Hill, 2007), it is, in contrast to the position of Cohen et al. (2011), ultimately counterproductive to the development of a meaningful critical response to the question of frequent flying and environmental damage… There is, of course, a deep irony in even trying to view frequent flying through the lens of addiction. Tourism, traditionally the realm of freedom, unconstraint and abandon (Crompton, 1979; Sharpley, 2003) is now recast as a pathology, associated with the pernicious tendencies of the human psyche.

Dr. Young and colleagues’ paper asserts that the idea that flying in extreme cases could be classed as a behavioural addiction is “unconvincing” (and again is something that I agree with). The paper also adapts the 2013 DSM-5 criteria for gambling disorder (substituting the word ‘gambling’ with ‘flying’) to highlight that while it is theoretically possible for someone to have an addiction to flying, it is highly unlikely even amongst the most frequent of flyers. As they note:

“A diagnosed flying addict (and some may exist) would appear to differ from the frequent flyer who is feeling guilty about the environmental consequences of flying. Indeed, the latter would appear to be entirely rational. Flying may be associated with feelings of guilt and suppression, but so are many other activities, like driving to work, using plastic bags, and using electricity from coal-powered generators. This does not make flying an addiction as defined by the DSM-5. In addition, a flying addict would be addicted to the act of flying when, in reality, people fly as part of a broader tourism or business journey or experience. Flying may be incidental to the motivations for travel, merely an unavoidable part of attaining a particular experience. In other words, the focus of flying addiction is likely to be complicated and shifting, unlike, for instance, gambling addiction, that is more clear-cut”.

Pathologizing a behaviour like flying may be stretching the addiction analogy a little too far, but I don’t see a theoretical reason why someone could not become addicted. However, it’s unknown as to what the actual object of flying addiction might be. Is it the actual flying and being in the air? The thrill of take-offs and landings? Is it the feeling of being attended and catered for (especially when flying business class) by the airline staff? Is it the anticipation associated of visiting somewhere new? All of these suggestions could be empirically tested but probably from a purely motivational view rather than from an addiction perspective.

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

Further reading

Burns, P., & Bibbings, L. (2009). The end of tourism? Climate change and societal challenges. 21st Century Society, 4(1), 31-51.

Clark, M., & Calleja, K. (2008). Shopping addiction: A preliminary investigation among Maltese university students. Addiction Research and Theory, 16(6), 633-649.

Cohen, S. A., Higham, J. E., & Cavaliere, C. T. (2011). Binge flying: Behavioural addiction and climate change. Annals of Tourism Research, 38(3), 1070-1089.

Crompton, J. (1979). Motivations for pleasure vacation. Annals of Tourism Research, 6(4), 408–424.

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

Griffiths, M.D. (2003). Tips on…Business travel abroad, British Medical Journal, 327, S38.

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

Griffiths, M.D. (2012). Tips on…Conference travel abroad. Psy-PAG Quarterly, 83, 4-6.

Higham, J. Cohen, S. & Cavaliere, C. (2013). ‘Climate breakdown’ and the ‘flyer’s dilemma’: Insights from three European societies. In: Fountain, J. & Moore, K. (Eds.). CAUTHE 2013: Tourism and Global Change: On the Edge of Something Big (pp. 321-324). Christchurch, N.Z.: Lincoln University.

Hill, A. (2007). Travel: The new tobacco. The Observer, May 6. Located at: http://www.guardian.co.uk/travel/2007/may/06/travelnews.climatechange

Hirschman, E. C. (1992). The consciousness of addiction: Toward a general theory of compulsive consumption. Journal of Consumer Research, 19(2), 155-179.

Randles, S., & Mander, S. (2009a). Practice(s) and ratchet(s): A sociological examination of frequent flying. In S. Gössling & P. Upham (Eds.), Climate change and aviation: Issues, challenges and solutions (pp. 245-271). London: Earthscan.

Rosenthal, E. (2010, 24 May). Can we kick our addiction to flying? Guardian, May 24. Located at: http://www.guardian.co.uk/environment/2010/may/24/kick- addiction-flying

Sharpley, R. (2003). Tourism, tourists and society. Huntingdon: Elm Publications.

Young, M., Higham, J.E.S. & Reis, A.C. (2014). ‘Up in the air’: A conceptual critique of flying addiction. Annals of Tourism Research, 49, 51-64.