Bed-ly serious: A brief look at ‘sleeping addiction’

As a life-long insomniac, I’ve always been interest in sleep at a personal level. In 1984, when I was studying for my psychology degree, the first ever research seminar I attended was one on the psychology of sleep by Dr. Jim Horne (who was, and I think still is, at Loughborough University). I found the lecture really interesting and although I never pursued a career in sleep research it was at that point that I started to take an interest more professionally. In my blog I’ve written a number of articles on various aspects of sleep including sexsomnia (engaging in sexual acts while sleeping, for instance, while sleepwalking), somnophilia (engaging in sexual acts while individuals are sleeping), Sleeping Beauty paraphilia (a sub-type of somnophilia in which individuals are sexually aroused by watching other people sleep), and lucid dreaming (where individuals are aware they are dreaming and exert some kind of control over the content of the dream),

More recently, I’ve been a co-author on a number of research papers in journals such as Sleep Medicine Reviews, Journal of Sleep Research, and Sleep and Biological Rhythms (see ‘Further reading below) but these have all involved either the effects of internet addiction on sleep or the psychometric evaluation of insomnia screening instruments rather than being about the psychology of sleep.

In a previous A-Z article on “strange and bizarre addictions” I included ‘sleep addiction’ as one of the entries. Obviously I don’t believe that sleeping can be an addiction (at least not by my own criteria) but the term ‘sleep addiction’ is sometimes used to describe the behaviour of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled ‘Those esoteric, exoteric and fantabulous diagnoses’ and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

In an online article entitled ‘Sleep addiction’, Amber Merton also mentioned clinomania in relation to an addiction to sleep:

“If you are obsessed with sleeping or have an intense desire to stay in bed, you could be suffering from a condition called clinomania. That doesn’t mean that there aren’t people who can experience symptoms similar to addiction and even withdrawal in association with sleep, or lack thereof”.

The reference to ‘addiction-like’ symptoms appears to have some validity based on these self-report accounts I found online. All of these individuals mention various similarities between their constant need for sleep and addiction. I have highlighted these to emphasize my assertions that some of the consequences are at the very least addiction-like:

• Extract 1: “I believe someone can become psychologically dependent on sleep. I am 47 and have used sleep for 40 years to escape from life…I typically sleep 4-6 hours too much each day. Sleep feels like an addiction to me because I crave it several times a day and am looking forward to how I can sneak it in. I don’t seem to be able to control it with will power for very long…I only have short periods when this isn’t a problem. When I am under stress it is at its worse. If I have any free or unstructured time, I can’t control how much I sleep excessively. When my time is heavily scheduled, I really struggle with keeping a full schedule and crave the time off when I can sleep for hours. If I know I’ll have a few hours in between activities free, I will find ways to sneak in some sleep. I am embarrassed about this, don’t tell the people around me the extent of the problems and devise ways to sneak in sleep without people knowing”.
• Extract 2: “I love sleeping. It feels so good I think I could even become addicted if I didn’t HAVE to wake up. I sleep about 12 hours every day and could sleep more if I didn’t have to do daily necessities. I am aware of the fact that people who generally sleep more than they are supposed to, die sooner and have other various health problems. To be honest I would rather sleep than do most things. I even choose sleep over sex a lot”.
• Extract 3: “I often sleep for 12-20 hours at a time. I have depression and am on anti-depressants. I just love sleeping. It’s so safe and comfy. I don’t know how else to explain it. It’s just amazing”.
• Extract 4: “I sleep AT LEAST 12 hours a day. But on days off I’ve been known to sleep for about 15-20 hours. [I am] addicted to sleep. I’ve cancelled social outings with friends pretending to be sick when really I just wanted to sleep in. I love sleep and I can’t get enough of it. I’ve slept through the entire weekend multiple times before, only waking up Monday morning when my alarm rang. And even after that much wonderful sleep I was still tired. The second I come home from work every day I eat, shower, and then crawl into bed and sleep the entire evening and night away. My alarm’s the only thing that can wake me up anymore…As for why I love sleep so much, I see a lot of people saying it’s an escape for them. For me it’s more, I don’t like people or going out or socializing, so sleep is my drug of choice. Is it bad? Maybe. Do I care? Not really…I more than love it, and it’s not hurting anyone if we’re being honest”.
• Extract 5: “I feel like I’m addicted to sleep. Here’s why I think though. I suffered for 13 years with depression and while I know I am still getting over it I don’t feel that’s the reason I’m addicted. During those 13 years I would have serious bouts of chronic insomnia. The doctors tried to many different sleeping medications, meditation, clinics to help me find a routine for natural sleep without meds. Nothing worked. Now I live in Thailand and my doctor here recommended melatonin tablets, all natural as your brain is supposed to produce it anyway to tell you when it’s dark it’s time to sleep and when it’s like light it’s time to wake up. She thinks my brain fails to produce certain chemicals as such with serotonin and now figured melatonin. Since I have been taking a melatonin supplement, I sleep so well, I fall asleep within 20 minutes and I sleep for AT LEAST 8 hours. When I wake up I just want to go back to sleep again because it feels amazing. I don’t feel like it’s part of my anxiety or my depression, I just think it’s because I had insomnia for so long its addictive!”
• Extract 6: “To be honest if I could I would sleep my life away. My so called normal sleeping pattern: I am awake all night. Fall asleep around 4am-8am. Sleep 12 hours. Repeat. My mind is a broken record, constantly repeating the trauma. I do suffer from depression and anxiety. Sleep is my addiction. When I sleep I feel SAFE regardless?”
• Extract 7: “I’ve been addicted to sleep (the escape from an abusive childhood, depression, and PTSD) since I was ten years old! I want to change though because my body is a mess. I’ve slept for 4 days and sometimes more with short awake periods to eat a little and use the potty. Not enough though, because now my body doesn’t work properly…Oversleeping has its consequences”.
• Extract 8: “I’m so pleased that I have found this site and other people who are addicted to sleep as this problem has plagued my adult life and I would like it to stop. Take today for instance, I woke at 5.30am and was quite awake feeling a little anxious but I could not wait to get to sleep again, so I did and stayed in bed till around 2.20 pm. I have many days like this and as the lady above the sleep state is quite lucid and I do seem to enjoy it rather than getting up and living life for real”.

Again, I reiterate that none of these individuals are addicted to sleep but in addition to the addiction-like descriptions, there is also crossover in the motivations for excessive sleep and motivations underlying addictions (most noticeably the association with depression, anxiety, psychological trauma, and using the activity as an escape). In relation to addiction, these extracts include references to salience (engaging in sleep to the neglect of everything else in their life), cravings (for sleep), the sleep being excessive, repetitive and habitual, sleep leading to negative consequences (conflict), and loss of control. The fact that many of these individuals describe their behaviour as an addiction or addictive doesn’t mean that it is.

While there is no academic paper that I know of that has ever claimed sleep can be a genuine addiction there are countless clinical and empirical papers examining excessive sleep (i.e., hypersomnia) and the different etiological pathways that can lead to hypersomnia. Although hypersomnia is not an addiction, those with the condition (like addicts) can suffer many negative side-effects from the relatively minor (e.g., low energy, fatigue, headaches, loss of appetite, restlessness, hallucinations) to the more severe (e.g., diabetes, obesity, heart disease, clinical depression, memory loss, suicidal ideation, and in extreme cases, death). In one online article I came across, the similarity between hypersomnia and addiction in relation to depression was evident:

“It’s important to note that in some cases separating cause from effect here can be muddled. For instance, does over sleeping contribute to depression or does depression contribute to oversleeping? Or are both oversleeping and depression the effect of a larger underlying cause? Furthermore, once a person is experiencing both, could they act to reinforce the other as a feedback loop?”

This observation could just as easily be made about most addictions (substance or behavioural). Finally, it’s worth noting that there are many sub-types of hypersomnia and excessive sleep. In a good review of hypersomnia [HS] in Current Neurology and Neuroscience Reports, Dr. Yves Dauvilliers notes the following hypersomnia sub-types (including narcolepsy which can include excessive sleep but isn’t usually classed as a type of hypersomnia; also note that ‘idiopathic’ means of unknown cause) which I have paraphrased below:

• Narcolepsy: This is a disabling neurologic disorder characterized by excessive daytime sleep (EDS) and cataplexy (i.e., a sudden loss of voluntary muscular tone without any alteration of consciousness in relation with strong emotive reactions such as laughter, joking).
• Narcolepsy without cataplexy: This is simply a variant of narcolepsy with cataplexy (but without the cataplexy).
• Idiopathic hypersomnia: Idiopathic HS is rare and remains a relatively poorly defined condition due to the absence of specific symptoms such as cataplexy or sleep apneas (i.e., loss of breathing while sleeping).
• Recurrent hypersomnia: This HS is characterized by repeated episodes of excessive sleep (at least 16 hours a day) lasting from a few days up to several weeks. The most well-known recurrent HS is Kleine-Levin syndrome which comprises both cognitive disturbances (feelings of confusion and unreality) and behavioural disturbances (such as overeating and hypersexual behaviour during symptomatic episodes).
• Hypersomnia associated with neurologic disorders: This type of HS causes EDS and can be a result of brain tumours, dysfunction in the thalamus, hypothalamus, or brainstem that may mimic idiopathic HS or narcolepsy.
• Hypersomnia associated with infectious disorders: This type of HS can be a result of viral infection such as HIV pneumonia, Whipple’s disease (a systemic disease most likely caused by a gram-positive bacterium), or Guillain-Barré syndrome (a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system).
• Hypersomnia associated with metabolic or endocrine disorders: This type of HS can be a result of conditions such as hyperthyroidism, diabetes, hepatic encephalopathy (a liver dysfunction among individuals with cirrhosis), and acromegaly (a hormonal disorder that develops when the pituitary gland produces too much growth hormone).
• Hypersomnia caused by drugs: This type of HS is secondary to many different types of drug medication including hypnotics, anxiolytics, antidepressants, neuroleptics, anti-histamines, and anti-epileptics.
• Hypersomnia not caused by drugs or known physiologic conditions: This type of HS can be caused by a range of disorders such as depressive disorder, seasonal affective disorder, and abnormal personality traits.

None of these types of HS is an addiction but clearly the negative consequences can be just as serious for the individual.

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

Further reading

Alimoradi, Z., Lin, C-Y., Broström, A., Bülow, P.H., Bajalan, Z., Griffiths, M.D., Ohayon, M.M. & Pakpour, A.H. (2019). Internet addiction and sleep problems: A systematic review and meta-analysis. Sleep Medicine Review, 47, 51-61.

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

Bener, A., Yildirim, E., Torun, P., Çatan, F., Bolat, E., Alıç, S., Akyel, S., & Griffiths, M.D. (2019). Internet addiction, fatigue, and sleep problems among students: A largescale survey study. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-018-9937-1

Billiard, M., & Dauvilliers, Y. (2001). Idiopathic hypersomnia. Sleep Medicine Reviews, 5(5), 349-358.

Dauvilliers, Y. (2006). Differential diagnosis in hypersomnia. Current Neurology and Neuroscience Reports, 6(2), 156-162.

Domenighini, A. (2016). Can you be addicted to sleep? Vice, January 24. Located at: https://www.vice.com/en_us/article/mg7e33/can-you-be-addicted-to-sleep

Hawi, N.S., Samaha, M., & Griffiths, M.D. (2018). Internet gaming disorder in Lebanon: Relationships with age, sleep habits, and academic achievement. Journal of Behavioral Addiction, 7, 70-78.

Mamun, M.A. & Griffiths, M.D. (2019). Internet addiction and sleep quality: A response to Jahan et al. (2019). Sleep and Biological Rhythms. doi: 10.1007/s41105-019-00233-0

Merton, A. (2008). Sleep addiction. Located at: https://www.plushbeds.com/blog/sleep-disorders/sleep-addiction/

Mignot, E. J. (2012). A practical guide to the therapy of narcolepsy and hypersomnia syndromes. Neurotherapeutics, 9(4), 739-752.

Pakpour, A., Lin, C-Y., Cheng, A.S., Imani, V., Ulander, M., Browall, M. Griffiths, M.D., Broström, A. (2019). A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer. Journal of Sleep Research. doi: 10.1111/jsr.12891.

Needers of the pack: A brief look at addiction to Solitaire

A few days ago I was interviewed by Business Insider about the addictiveness of the card game Solitaire (also known as Klondike and Patience). The ‘hook’ for the Business Insider article (no pun intended) was that May 22 is National Solitaire Day (NSD). A quick look on the online National Day Calendar confirmed that NSD does indeed exist (a celebration day that only began for the first time last year) and the website also pointed out that the game is over 200 years’ old and that Solitaire “truly went viral” in 1990 when Microsoft included the Microsoft Solitaire game in Windows 3.0 (as a way to teach people how to use the mouse on their computers). The NSD webpage notes that:

“Over the past 28 years, Microsoft Solitaire has been providing great entertainment to hundreds of millions of players in every corner of the world…In 2012, Microsoft evolved Solitaire into the Microsoft Solitaire Collection, which features five of the top Solitaire games in one app. Since then, the game has been played by over 242 million people and has become so popular that each year 33 billion games are played with over 3.2 trillion cards dealt!”

Back in 2000, a short article on internet addiction in The Lancet by Peter Mitchell noted that one of the pioneers in internet addiction research, the clinical psychologist Maressa Hecht Orzack claimed to have a problem (a “near addiction”) playing Solitaire. Orzack was quoted in Mitchell’s article as saying: “So now I don’t have a computer at work. [My playing Solitaire] was getting that serious”. Orzack was also quoted in the Business Insider article. Her Solitaire playing was a “growing obsession” and she neglected her work and lost sleep because of her Solitaire playing. She said: “I kept playing solitaire more and more – my late husband would find me asleep at the computer. I was missing deadlines. I knew something had to be done”.

As far as I am aware, there is no empirical research about addiction to Solitaire, and I’ve never come across a published case study. However, I have mentioned Solitaire in a number of my papers over the years but all of them were in my critique of Dr. Kimberley Young’s taxonomy of the different types of internet addiction. Young claimed there were five different types of internet addiction (‘cyber-sexual addiction’, cyber-relationship addiction, ‘net compulsions’, ‘information overload’ and ‘computer addiction’). In a number of my publications in journals such as the Student British Medical Journal (1999), Addiction Research (2000), and the International Journal of Mental Health and Addiction (2006), I argued that the typology was flawed and that most of the examples Young provided were addictions on the internet, not addictions to the internet (and echoing my assertion that individuals are no more addicted to the internet than alcoholics are addicted to bottles).

The reference to Solitaire was in relation to Young’s final type of internet addiction – ‘computer addiction’. One of her examples of ‘computer addiction’ as the playing of Solitaire on computers. (I found this strange particularly because the example didn’t even rely on being on the internet – it was merely about individuals being addicted to playing Solitaire on computers and laptops). Young never provided any empirical evidence that she had ever met or treated anyone with an addiction to Solitaire, just that being addicted to Solitaire would be classed as a ‘computer addiction’ in her typology.

Young is not the only social scientist to use Solitaire as an example in an addiction typology. In a 2008 paper published in the Journal of Applied Social Science, Jawad Fatayer outlined what he believes are the four types of addiction – alpha addictions (addictions that impact the body and physical health such as nicotine addiction and food addiction), beta addictions (addictions that impact the mind and the body such as alcohol and other drug addictions), gamma addictions (all behavioural addictions), and delta addictions (two or more addictions experiences simultaneously). Addiction to Solitaire was listed as a gamma addiction (but again, there was no empirical evidence to support the claim that Solitaire addiction actually exists).

Business Insider spoke to two other psychologists in addition to myself. Dr. Chris Ferguson (with whom I have co-authored a few papers) said:

“It’s important to recognize the difference between really liking something and having a clinical addiction. People (say) ‘I’m addicted to cupcakes’, ‘I’m addicted to chocolate’ meaning ‘This is a really fun thing that I like to do a lot’. There’s a huge debate that goes on in the field right now about whether video games can be compared to things like substance abuse, or if video games are more similar to hobby-like activities that many people enjoy — and some people might overdo…a fixation with Solitaire is more of a behavioral addiction – an obsessive behavioral pattern that can be a sign of underlying mental distress or illness. People who have mental health issues, or are simply under stress, tend to be drawn to things that are fun and distracting. And that’s mostly good, actually. It’s just that sometimes, for some individuals, they may begin to really overdo those activities as a form of escapism…It’s not about technology. It’s about mental health”.

A clinical psychologist, Anthony Bean said:

“There are some clear signs that Solitaire might be playing too big a role in your life. (If you’re) noticing you’re putting more time than other areas into the game and, let’s say, not paying attention to your family, not paying attention to work, not paying attention to school”.

My contribution to the Business Insider was taken from an email I sent the journalist. Very little of what I sent was used. I was asked two specific questions: (i) what characteristics of the game Solitaire might make it addicting? and (ii) what should people be aware of as signs of a disruptive addiction to Solitaire (or gaming in general)?

In answer to the first question, I wrote that addictions rely on constant rewards (what psychologists refer to as reinforcement) and each game of Solitaire can be played quickly and individuals can be quickly rewarded if they win (positive reinforcement) but when they lose, the feeling of disappointment or cognitive regret can be eliminated by playing again straight away (negative reinforcement – playing as way to relive a dysphoric mood state). I also stated that addictions typically result as a coping mechanism to other things in a person’s life. They use such behaviours as a way of escape and the repetitive playing of games can help in such circumstances. For the overwhelming majority of people, such playing behaviour will be an adaptive coping mechanism but if the game takes over all other aspects of the person’s life and compromises their relationships and their education/occupation (depending upon their age), this becomes a poor coping strategy because the short-term benefits are heavily outweighed by the long-term costs.

In relation to the second question, I outlined what I believe to be the six core criteria of addictive behaviour and outlined them with what I believed a genuine Solitaire addiction would constitute. My response was purely hypothetical because I have never met or even heard of anyone being genuinely addicted to Solitaire. So, hypothetically, Solitaire addiction would comprise anyone that fulfilled all of the following six criteria:

• Salience –This occurs when Solitaire becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually playing Solitaire they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with Solitaire).
• Mood modification –This refers to the subjective experiences that people report as a consequence of playing Solitaire 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 time spent playing Solitaire are required to achieve the former mood modifying effects. This basically means that for someone engaged in Solitaire, they gradually build up the amount of the time they spend playing Solitaire 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 play Solitaire because they are ill, have no computer connection, etc.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time playing Solitaire
• Relapse– This is the tendency for repeated reversions to earlier patterns of excessive Solitaire playing to recur and for even the most extreme patterns typical at the height of excessive Solitaire playing to be quickly restored after periods of control.

Finally, I just want to reiterate that I know of no evidence to support the contention that there are individuals genuinely addicted to Solitaire. However, I do think it’s theoretically possible even though I’ve yet to meet or hear about such individuals.

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

Further reading

Fatayer, J. (2008). Addiction types: A clinical sociology perspective. Journal of Applied Social Science, 2(1), 88-93.

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

Griffiths, M.D. (1999). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

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

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

Mitchell, P. (2000). Internet addiction: genuine diagnosis or not? The Lancet, 355(9204), 632.

National Day Calendar (2018). National Solitaire Day. Located at: https://nationaldaycalendar.com/national-solitaire-day-may-22/

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

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

Trait expectations: Another look at why addictive personality is a complete myth

In the 30 years that I have been carrying out research into addiction, the one question that I have been asked the most – particularly by those who work in the print and broadcast media – is whether there is such a thing as an ‘addictive personality’? In a previous blog I briefly reviewed the concept of ‘addictive personality’ but since publishing that article, I have published a short paper in the Global Journal of Addiction and Rehabilitation Medicine on addictive personality, and in this blog I review I outline some of the arguments as to why I think addictive personality is a complete myth.

Psychologists such as Dr. Thomas Sadava have gone as far to say that ‘addictive personality’ is theoretically necessary, logically defensible, and empirically supportable. Sadava argued that if ‘addictive personality’ did not exist then every individual would vulnerable to addiction if they lived in comparable environments, and that those who were addicted would differ only from others in the specifics of their addiction (e.g., alcohol, nicotine, cocaine, heroin). However, Sadava neglected genetic/biological predispositions and the structural characteristics of the substance or behaviour itself.

There are many possible reasons why people believe in the concept of ‘addictive personality’ including the facts that: (i) vulnerability is not perfectly correlated to one’s environment, (ii) some addicts are addicted to more than one substance/activity (cross addiction) and engage themselves in more than one addictive behaviour, and (iii) on giving up addiction some addicts become addicted to another (what I and others have referred to as ‘reciprocity’). In all the papers I have ever read concerning ‘addictive personality’, I have never read a good operational definition of what ‘addictive personality’ actually is (beyond the implicit assumption that it refers to a personality trait that helps explain why individuals become addicted to substances and/or behaviours). Dr. Craig Nakken in his book The Addictive Personality: Understanding the Addictive Process and Compulsive Behaviour argued that ‘addictive personality’ is “created from the illness of addiction”, and that ‘addictive personality’ is a consequence of addiction and not a predisposing factor. In essence, Nakken simply argued that ‘addictive personality’ refers to the personality of an individual once they are addicted, and as such, this has little utility in understanding how and why individuals become addicted.

When teaching my own students about the concept of ‘addictive personality’ I always tell them that operational definitions of constructs in the addictive behaviours field are critical. Given that I have never seen an explicit definition of ‘addictive personality’ I provide my own definition and argue that ‘addictive personality’ (if it exists) is a cognitive and behavioural style which is both specific and personal that renders an individual vulnerable to acquiring and maintaining one or more addictive behaviours at any one time. I also agree with addiction experts that the relationship between addictive characteristics and personality variables depend on the theoretical considerations of personality. According to Dr. Peter Nathan there must be ‘standards of proof’ to show valid associations between personality and addictive behaviour. He reported that for the personality trait or factor to genuinely exist it must: (i) either precede the initial signs of the disorder or must be a direct and lasting feature of the disorder, (ii) be specific to the disorder rather than antecedent, coincident or consequent to other disorders/behaviours that often accompany addictive behaviour, (iii) be discriminative, and (iv) be related to the addictive behaviour on the basis of independently confirmed empirical, rather than clinical, evidence. As far as I am aware, there is no study that has ever met these four standards of proof, and consequently I would argue on the basis of these that there is no ‘addictive personality’.

Although I do not believe in the concept of ‘addictive personality’ this does not mean that personality factors are not important in the acquisition, development, and maintenance of addictive behaviours. They clearly are. For instance, a paper in the Psychological Bulletin by Dr. Roman Kotov and his colleagues examined the associations between substance use disorders (SUDs) and higher order personality traits (i.e., the ‘big five’ of openness to experience, conscientiousness, agreeableness, extraversion, and neuroticism) in 66 meta-analyses. Their review included 175 studies (with sample sizes ranged from 1,076 to 75,229) and findings demonstrated that SUD addicts were high on neuroticism (and was the strongest personality trait associated with SUD addiction) and low on conscientiousness. Many of the studies the reviewed also reported that agreeableness and openness were largely unrelated to SUDs.

Dr. John Malouff and colleagues carried published a meta-analysis in the Journal of Drug Education examining the relationship between the five-factor model of personality and alcohol. The meta-analysis included 20 studies (n=7,886) and showed alcohol involvement was associated with low conscientiousness, low agreeableness, and high neuroticism. Mixed-sex samples tended to have lower effect sizes than single-sex samples, suggesting that mixing sexes in data analysis may obscure the effects of personality. Dr. James Hittner and Dr. Rhonda Swickert published a meta-analysis in the journal Addictive Behaviors examining the association between sensation seeking and alcohol use. An analysis of 61 studies revealed a small to moderate size heterogeneous effect between alcohol use and total scores on the sensation seeking scale. Further analysis of the sensation seeking components indicated that disinhibition was most strongly correlated with alcohol use.

Dr. Marcus Munafo and colleagues published a meta-analysis in the journal Nicotine and Tobacco Research examining strength and direction of the association between smoking status and personality. They included 25 cross-sectional studies that reported personality data for adult smokers and non-smokers and reported a significant difference between smokers and non-smokers on both extraversion and neuroticism traits. In relation to gambling disorder, Dr. Vance MacLaren and colleagues published a meta-analysis of 44 studies that had examined the personality traits of pathological gamblers (N=2,134) and non-pathological gambling control groups (N=5,321) in the journal Clinical Psychology Review. Gambling addiction was shown to be associated with urgency, premeditation, perseverance, and sensation seeking aspects of impulsivity. They concluded that individual personality characteristics may be important in the aetiology of pathological gambling and that the findings were similar to the meta-analysis of substance use disorders by Kotov and colleagues.

More recently, I co-authored a study with Dr. Cecilie Andreassen and her colleagues in the Journal of Behavioral Addictions. We carried out the first ever study investigating the inter-relationships between the ‘big five’ personality traits and behavioural addictions. They assessed seven behavioural addictions (i.e., Facebook addiction, video game addiction, Internet addiction, exercise addiction, mobile phone addiction, compulsive buying, and study addiction). Of 21 inter-correlations between the seven behavioural addictions, all were positive (and nine significantly so). More specifically: (i) neuroticism was positively associated with Internet addiction, exercise addiction, compulsive buying, and study addiction, (ii) extroversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying, (iii) openness was negatively associated with Facebook addiction and mobile phone addiction, (iv) agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying, and (v) conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying and positively associated with exercise addiction and study addiction. However, replication and extension of these findings is needed before any definitive conclusions can be made.

Overall these studies examining personality and addiction consistently demonstrate that addictive behaviours are correlated with high levels of neuroticism and low levels of conscientiousness. However, there is no evidence of a single trait (or set of traits) that is predictive of addiction, and addiction alone. Others have also reached the same conclusion based on the available evidence. For instance, R.G. Pols (in Australian Drug/Alcohol Review) noted that findings from prospective studies are inconsistent with retrospective and cross-sectional studies leading to the conclusion that the ‘addictive personality’ is a myth. Dr. John Kerr in the journal Human Psychopharmacology: Clinical and Experimental noted that ‘addictive personality’ had long been argued as a viable construct (particularly in the USA) but that there is simply no evidence for the existence of a personality type that is prone to addiction. In another review of drug addictions, Kevin Conway and colleagues asserted (in the journal Drug and Alcohol Dependence) there was scant evidence that personality traits were associated with psychoactive substance choice. Most recently, Maia Szalavitz in her book Unbroken Brain: A Revolutionary New Way of Understanding Addiction noted that:

“Fundamentally, the idea of a general addictive personality is a myth. Research finds no universal character traits that are common to all addicted people. Only half have more than one addiction (not including cigarettes)—and many can control their engagement with some addictive substances or activities, but not others”.

Clearly there are common findings across a number of differing addictions (such as similarities in personality profiles using the ‘big five’ traits) but it is hard to establish whether these traits are antecedent to the addiction or caused by it. Within most addictions there appear to be more than one sub-type of addict suggesting different pathways of how and way individuals might develop various addictions. If this is the case – and I believe that it is – where does that leave the ‘addictive personality’ construct?

‘Addictive personality’ is arguably a ‘one type fits all’ approach and there is now much evidence that the causes of addiction are biopsychosocial from an individual perspective, and that situational determinants (e.g., accessibility to the drug/behaviour, advertising and marketing, etc.) and structural determinants (e.g., toxicity of a specific drug, game speed in gambling, etc.) can also be influential in the aetiology of problematic and addictive behaviours. Another problem with ‘addictive personality’ being an explanation for why individuals develop addictions is that the concept inherently absolves an individual’s responsibility of developing an addiction and puts the onus on others in treating the addiction. Ultimately, all addicts have to take some responsibility in the development of their problematic behaviour and they have to take some ownership for overcoming their addiction. Personally, I believe it is better to concentrate research into risk and protective factors of addiction rather than further research of ‘addictive personality’.

As I have argued in a number of my papers and book chapters, not every addict has a personality disorder, and not every person with a personality disorder has an addiction. While some personality disorders appear to have an association with addiction including Antisocial Personality Disorder and Borderline Personality Disorder, just because a person has some of the personality traits associated with addiction does not mean they are, or will become, an addict. Practitioners consider specific personality traits to be warning signs, but that’s all they are. There is no personality trait that guarantees an individual will develop an addiction and there is little evidence for an ‘addictive personality’ that is predictive of addiction alone. In short, ‘addictive personality’ is a complete myth.

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

Further reading

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

Conway, K. P., Kane, R. J., Ball, S. A., Poling, J. C., & Rounsaville, B. J. (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence, 71(1), 65-75.

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

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

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

Griffiths, M.D. (2009). The psychology of addictive behaviour. In: M. Cardwell, M., L. Clark, C. Meldrum & A. Waddely (Eds.), Psychology for A2 Level (pp. 236-471). London: Harper Collins.

Griffiths, M.D. (2017). The myth of ‘addictive personality’. Global Journal of Addiction and Rehabilitation Medicine, 3(2), 555610.

Hittner, J. B., & Swickert, R. (2006). Sensation seeking and alcohol use: A meta-analytic review. Addictive Behaviors, 31(8), 1383-1401.

Kerr, J. S. (1996). Two myths of addiction: The addictive personality and the issue of free choice. Human Psychopharmacology: Clinical and Experimental, 11(S1), S9-S13.

Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin, 136(5), 768-821.

MacLaren, V. V., Fugelsang, J. A., Harrigan, K. A., & Dixon, M. J. (2011). The personality of pathological gamblers: A meta-analysis. Clinical Psychology Review, 31(6), 1057-1067.

Malouff, J. M., Thorsteinsson, E. B., Rooke, S. E., & Schutte, N. S. (2007). Alcohol involvement and the Five-Factor Model of personality: A meta-analysis. Journal of Drug Education, 37(3), 277-294.

Munafo, M. R., Zetteler, J. I., & Clark, T. G. (2007). Personality and smoking status: A meta-analysis. Nicotine & Tobacco Research, 9(3), 405-413.

Nakken, C. (1996). The addictive personality: Understanding the addictive process and compulsive behaviour. Hazelden, Center City, MN: Hazelden.

Nathan, P. E. (1988). The addictive personality is the behavior of the addict. Journal of Consulting and Clinical Psychology, 56(2), 183-188.

Pols, R. G. (1984). The addictive personality: A myth. Australian Alcohol/Drug Review, 3(1), 45-47.

Sadava, S.W. (1978). Etiology, personality and alcoholism. Canadian Psychological Review/Psychologie Canadienne, 19(3), 198-214.

Szalavitz M (2016). Unbroken brain: A revolutionary new way of understanding addiction. St. Martin’s Press, New York.

Szalavitz M (2016). Addictive personality isn’t what you think it is. Scientific American, April 5.

Story rebellion: A brief look at ‘news addiction’

Earlier this year, I was contacted by a BBC reporter asking me what the latest research on ‘news addiction’ was. I politely told him I was unaware of any such research and that if ‘news addiction’ existed, it would be more akin to ‘television addiction’ or ‘boxset bingeing’. About a month after that call, a paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Pakistani psychologists Ghulam Ishaq, Rafia Rafique, and Muhammad Asif.

I have to admit that some might say I’m a bit of a ‘news junkie’. As soon as I get up in the morning or as soon as I come home from work I switch on the radio or television to listen to the news. However, I do not consider my love of listening to the news to be an addiction, and I suspect most people like me wouldn’t either. Of course, there are now other ways for individuals to get their ‘news fix’ including thousands of online news sites and via social media which is why Ishaq and his colleagues decided to look at the construct of ‘news addiction’. They claimed that:

“People are persuaded towards news. Similarly, engrossment of certain individuals in any domain from politics, sports, global issues, arson or terrorism can also promote news habituation or addiction and intensify inspection towards news. News addiction comes under the term behavioral-related behavior…When somebody interacts with news, this gives him/her satisfying feelings and sensations that he/she is not able to get in other ways. The reinforcement an individual gets from these feelings compels him to repeat their behavior to get these types of feelings and sensations repeatedly… eventually causing a disturbance in every sphere of life… individuals who are addicted to news feel themselves much obsessed to check the news in uncontrollable ways”.

Theoretically there is no reason why individuals cannot be addicted to reading and/or listening to the news as long as they are being constantly rewarded for their behaviour. In fact, the authors used some of my papers on behavioural addiction more generally to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. In their study, Ishaq and colleagues wanted to examine the relationship between (the personality construct of) conscientiousness, neuroticism, self-control, and news addiction. Conscientiousness is a personality trait and refers to individuals who are orderly, careful, and well organised. Neuroticism is another major personality trait and refers to individuals who have high mental instability such as depression and high anxiety. The researchers hypothesised that there would be negative correlation between conscientiousness and news addiction, and that neuroticism would be positively correlated with news addiction.

To test their hypotheses, a survey was completed by 300 participants (aged 18 to 60 years; average age 39 years) from major cities of the Punjab (Lahore, Multan, Bahawalpur, Faisalabad, Sargodha). The authors developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. They also administered the ‘Big Five Inventory’ (which assesses five major personality traits – Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism). The study found that the hypotheses were supported (i.e., news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Previous literature has consistently shown that there is relationship between personality traits and behavioural addiction. The findings of this study are very similar to those more widely in the general literature for both substance and behavioural addictions (which also show most addictions have a low correlation with conscientiousness and a high correlation with neuroticism). The authors also argued that:

“(The findings show that) self-control plays an active role [in] refraining from the instant pleasure of impulse that would hinder with daily functioning and attainment goals…[The] current study findings demonstrated that self-control acts as a mediating variable between conscientiousness, neuroticism and news addiction”.

They also reported that females had higher scores on neuroticism and conscientiousness and that males had higher scores on the News Addiction Scale. The authors also claimed that there was much similarity between social media addiction (although provided no evidence for this except to say that they were both examples of behavioural addiction).

There was no mention at all in the paper about how their participants accessed their news. I access most (but certainly not all) of my news via television and therefore if I was watching an abnormal amount of news on the television, this would more likely be a sub-type of television addiction or a sub-type of television binge-watcher (both of which have been reported in the psychological literature). If someone addictively accessed all their news online or via social media, this could perhaps come under more general umbrella terms such as ‘internet addiction’ or ‘social media addiction’.

However, things are further complicated by the fact that ‘news’ can be defined in a number of ways. In the study by Ishaq and colleagues, news was defined as a “statement of specific information and facts and figures on any substantial event” but such a definition doesn’t take into account such things as political opinions and nor does it define what a ‘substantial event’ is. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.

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

Further reading

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

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

Ishaq, G., Rafique, R., & Asif, M. (2017). Personality traits and news addiction: Mediating role of self-control. Journal of Dow University of Health Sciences, 11(2), 31-53.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Orosz, G., Vallerand, R. J., Bőthe, B., Tóth-Király, I., & Paskuj, B. (2016). On the correlates of passion for screen-based behaviors: The case of impulsivity and the problematic and non-problematic Facebook use and TV series watching. Personality and Individual Differences, 101, 167-176.

Sussman, S., & Moran, M.B. (2013). Hidden addiction: Television. Journal of Behavioral Addictions, 2(3), 125-132.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2017). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Get connected: Another brief look at social networking addiction

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

There is a growing scientific evidence base to suggest excessive SNS use may lead to symptoms traditionally associated with substance-related addictions. These symptoms have been described as salience, mood modification, tolerance, withdrawal, relapse, and conflict with regards to behavioural addictions, and were validated in the context of the Internet addiction components model in a study I co-wrote with Dr. Daria Kuss and colleagues in a 2014 issue of the International Journal of Mental Health and Addiction (see ‘Further reading’ below)

For a small minority of individuals, their use of social networking sites may become the single most important activity that they engage in, leading to a preoccupation with SNS use (salience). The activities on these sites are then being used in order to induce mood alterations, pleasurable feelings or a numbing effect (mood modification). Increased amounts of time and energy are required to be put into engaging with SNS activities in order to achieve the same feelings and state of mind that occurred in the initial phases of usage (tolerance). When SNS use is discontinued, addicted individuals will experience negative psychological and sometimes physiological symptoms (withdrawal), often leading to a reinstatement of the problematic behaviour (relapse). Problems arise as a consequence of the engagement in the problematic behaviour, leading to intrapsychic (conflicts within the individual often including a subjective loss of control) and interpersonal conflicts (i.e., problems with the immediate social environment including relationship problems and work and/or education being compromised).

Whilst referring to an ‘addiction’ terminology in this blog it needs to be noted that there is obviously a lot of controversy within the research field concerning both the possible over-pathologising of everyday life as well as the most appropriate term for the phenomenon. On the one hand, current behavioural addiction research tends to be correlational and confirmatory in nature and is often based on population studies rather than clinical samples in which psychological impairments are observed. On the other hand, much of my own research does not discriminate between the label addiction, compulsion, problematic SNS use, or other similar labels used because these terms are being used interchangeably by most authors in the field. Nevertheless, when referring to ‘addiction’, the I refer to the presence of the above stated criteria, as these appear to hold across both substance-related as well as behavioural addictions and indicate the requirement of significant impairment and distress on behalf of the individual experiencing it in order to qualify for using clinical terminology such as the ‘addiction’ label.

The question then arises as what it is that individuals become addicted to. Is it the technology or is it more what the technology allows them to do? I have constantly argued in many of my papers that the technology is but a medium or a tool that allows individuals to engage in particular behaviours, such as social networking and gaming, rather than being addictive per se. This view is supported by media scholars such as Dr. Danah Boyd: “To an outsider, wanting to be always-on may seem pathological. All too often it’s labelled an addiction. The assumption is that we’re addicted to the technology. The technology doesn’t matter. It’s all about the people and information”. Following this thinking, one could claim that it is not an addiction to the technology, but to connecting with people, and the good feelings that ‘likes’ and positive comments of appreciation can produce. Given that connection is the key function of social networking sites, it appears that ‘social networking addiction’ may be considered an appropriate denomination of this potential mental health problem.

There are a numbers of models which offer explanations as to the development of SNS addiction. For instance, in the cognitive-behavioural model forwarded by Ofir Turel and Alexander Serenko, excessive social networking is the consequence of maladaptive cognitions and is exacerbated through a number of external issues, resulting in addictive use. The social skill model suggests individuals use SNSs excessively as a consequence of low self-presentation skills and preference for online social interaction over face-to-face communication, resulting in addictive SNS use. With respect to the socio-cognitive model, excessive social networking develops as a consequence of positive outcome expectations, Internet self-efficacy, and limited Internet self-regulation, leading to addictive SNS use.

It has furthermore been suggested that SNS use may become problematic when individuals use it in order to cope with everyday problems and stressors, including loneliness and depression. More specifically, it has been contended that excessive SNS users find it difficult to communicate face-to-face, and social media use offers a variety of immediate rewards, such as self-efficacy and satisfaction, resulting in continued and increased use, with the consequence of exacerbating problems, including neglecting offline relationships, and problems in professional contexts. The resultant depressed moods are then dealt with by continued engagement in SNSs, leading to a vicious cycle of addiction.

Cross-cultural research by Artemis Tsitsika and colleagues (published in 2014 issue of the Journal of Adolescent Health) comprised 10,930 adolescents from six European countries (Greece, Spain, Poland, the Netherlands, Romania and Iceland). Findings showed that using SNS for two or more hours a day was related to internalizing problems, and decreased academic performance and activity. A study by Chong-wen Wang and colleagues (published in a 2015 issue of Addictive Behaviors) surveyed a sample of 920 secondary school students in China and indicated neuroticism and extraversion predicted SNS addiction, clearly differentiating individuals who experience problems as a consequence of their excessive SNS use from those individuals who used games or the Internet in general excessively, further contributing to the contention that SNS addiction appears to be a behavioural problem separate from the more commonly researched gaming addiction. In a study using a relatively small representative sample of the Belgian population (N=1000), a study by Rozane De Cock and colleagues (published in a 2014 issue of Cyberpsychology, Behavior and Social Networking) suggested 6.5% were using SNSs compulsively, with this group having lower scores on measures of emotional stability and agreeableness, conscientiousness, perceived control and self-esteem, and higher scores on loneliness and depressive feelings.

The way forward in the emerging research field of social networking addiction requires the establishment of consensual nosological precision, so that both researchers and clinical practitioners can work together and establish productive communication between the involved parties that enable reliable and valid assessments of SNS addiction and associated behaviors (e.g., problematic mobile phone use), and the development of targeted and specific treatment approaches to ameliorate the negative consequences of such disorders.

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

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

Further reading

Andreassen, C. S. (2015). Online social network site addiction: A comprehensive review. Current Addiction Reports, 2(2), 175-184.

Billieux, J.; Schimmenti, A.; Khazaal, Y.; Maurage, P.; Heeren, A. Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of Behavioral Addictions 2015, 4, 119-123.

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

De Cock, R., Vangeel, J., Klein, A., Minotte, P., Rosas, O., & Meerkerk, G.J. (2014). Compulsive use of social networking sites in Belgium: Prevalence, profile, and the role of attitude toward work and school. CyberPsychology, Behavior and Social Networking, 17, 166-171. 

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

Kardefelt-Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., Maurage, P., Carras, M., Edman, J., Blaszczynski, A., Khazaal, Y., & Billieux, J. (2017). How can we conceptualize behavioural addiction without pathologizing common behaviours? Addiction, 15, 13763.

Kuss, D. J., & Griffiths, M. D. (2012). Internet gaming addiction: A systematic review of empirical research. International Journal of Mental Health and Addiction, 10(2), 278-296.

Kuss, D. J., Shorter, G. W., van Rooij, A. J., Griffiths, M. D., & Schoenmakers, T. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12(3), 351-366.

Tsitsika, A.K., Tzavela, E.C., Janikian, M., Ólafsson, K., Iordache, A., Schoenmakers, T.M., Tzavara, C., & Richardson, C. (2014). Online social networking in adolescence: Patterns of use in six European countries and links with psychosocial functioning. Journal of Adolescent Health, 55, 141-147.

Turel, O., & Serenko, A. (2012). The benefits and dangers of enjoyment with social networking websites. European Journal of Information Systems, 21(5), 512-528.

Wang, C.-W., Ho, R.T.H., Chan, C.L.W., & Tse, S. (2015). Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: Trait differences for gaming addiction and social networking addiction. Addictive Behaviors, 42, 32-35.

Tubular hells: A brief look at ‘addiction’ to watching YouTube videos

 

A few days ago, I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). As Gaita reported:

“The story profiles a middle school student whose obsessive viewing of YouTube content led to extreme behavior changes and eventually, depression and a suicide attempt. The student finds support through therapy at an addiction recovery center…The student in question is a young girl named Olivia who felt at odds with the ‘popular’ kids at her Oakland area school. She began watching YouTube videos after hearing that it was a socially acceptable thing to do… Her viewing habits soon took the place of sleep, which impacted her energy and mood. Her grades began to falter, and external problems within her house – arguments between her parents and the death of her grandmother – led to depression and an admission of wanting to hang herself. Her parents took her to a psychiatric hospital, where she stayed for a week under suicide watch, but her self-harming compulsion continued after her release. She began viewing videos about how to commit suicide, which led to an attempt to overdose on Tylenol” [Note: The name of the woman – Olivia – was a pseudonym].

McClurg interviewed Olivia’s mother for the PBS article and it was reported that Olivia went from being a “bubbly daughter…hanging out with a few close friends after school” to “isolating in her room for hours at a time”. Olivia’s mother also claimed that her daughter had “always been kind of a nerd, a straight. A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked a lot about their latest YouTube favorites”. According to news reports, all Olivia would do was to watch video after video for hours and hours on end and developed sleeping problems. Over time, the videos being watched focused on fighting girls and other videos featuring violence.

The news story claimed that Olivia was “diagnosed with depression that led to compulsive internet use”. When Olivia went back home she was still feeling suicidal and then spent hours watching YouTube videos on how to commit suicide (and it’s where she got the idea for overdosing on Tylenol tablets).

After a couple of spells in hospital, Olivia’s parents took her to a Californian centre specialising in addiction recovery (called ‘Paradigm’ in San Rafael). The psychologist running the Paradigm clinic (Jeff Nalin) claimed Olivia’s problem was “not uncommon” among clients attending the clinic. Nalin believes (as I do and have pointed out in my own writings) that treating online addictions is not about abstinence but about getting the behaviour under control but developing skills to deal with the problematic behaviour. He was quoted as saying:

“I describe a lot of the kids that we see as having just stuck a cork in the volcano. Underneath there’s this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt…The best analogy is when you have something like an eating disorder. You cannot be clean and sober from food. So, you have to learn the skills to deal with it”.

The story by Gaita asked the question of whether compulsive use of watching YouTube could be called a genuine addiction (and that’s where my views based on my own research were used). I noted that addiction to the internet may be a symptom of another addiction, rather than an addiction unto itself. For instance, people addicted to online gambling are gambling addicts, not internet addicts. An individual addicted to online gaming or online shopping are addicted to gaming or shopping not to the internet.

An individual may be addicted to the activities one can do online and is not unlike saying that an alcoholic is not addicted to a bottle, but to what’s in it. I have gone on record many times saying that I believe anything can be addictive as long there are continuous rewards in place (i.e., constant reinforcement). Therefore, it’s not impossible for someone to become addicted to watching YouTube videos but the number of genuine cases of addiction are likely to be few and far between. Watching video after video is conceptually no different from binge watching specific television series or television addiction itself (topics that I have examined in previous blogs).

I ought to end by saying that some of my own research studies on internet addiction (particularly those co-written with Dr. Attila Szabo and Dr. Halley Pontes and published in the Journal of Behavioral Addictions and Addictive Behaviors Reports – see ‘Further reading’ below) have examined the preferred applications by those addicted to the internet, and that the watching of videos online is one of the activities that has a high association with internet addiction (along with such activities such as social networking and online gaming). Although we never asked participants to specify which channel they watched the videos, it’s fair to assume that many of our participants will have watched them on YouTube), and (as the Camelot lottery advert once said) maybe, just maybe, a few of those participants may have had an addiction to watching YouTube videos.

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

Further reading

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

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

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

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

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

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

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

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

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

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

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

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

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

Search of the poisoned mind? A brief look at ‘internet search dependence’

Despite being a controversial topic, research into a wide variety of online addictions has grown substantially over the last decade. My own research into online addictions has been wide ranging and has included online social networking, online sex addiction, online gaming addiction, online shopping addiction, and online gambling addiction. As early as the late 1990s/early 2000s, I constantly argued that when it came to online addictions, most of those displaying problematic behaviour had addictions on the internet rather than addictions to the internet (i.e., they were not addicted to the medium of the internet but addicted to applications and activities that could be engaged in via the internet).

A recent 2016 paper by Dr. Yifan Wang and colleagues in the journal Frontiers in Public Health described the development of the Questionnaire of Internet Search Dependence (QISD), a tool developed to assess individuals who may be displaying a dependence on using online search engines (such as Google and Baidu). The notion of individuals being addicted to using search engines is not new and was one of five types of internet addiction outlined in a 1999 typology in a paper in the Student British Medical Journal by Dr. Kimberley Young (and what she termed ‘information overload’ and referred to compulsive database searching). Although I criticized the typology on the grounds that most of the types of online addict were not actually internet addicts but were individuals using the medium of the internet to fuel other addictive behaviours (e.g., gambling, gaming, day trading, etc.), I did implicitly acknowledge that activities such as internet database searching could theoretically exist, even if I did not think it was a type of internet addiction.

As far as I am aware, the new scale developed by Wang et al. (2016) is the first to create and psychometrically evaluate an instrument to assess ‘internet search dependence’. As noted by the authors:

“Subsequently, we compiled 16 items to represent psychological characteristics associated with Internet search dependence, based on the literature review and a follow-up interview with 50 randomly selected university students…We adopted the six criteria for behavioral addiction formulated by Griffiths (i.e., salience, mood modification, tolerance, withdrawal, conflict, and relapse) [Griffiths, 1999b]”.

Given the authors claimed they used an early version of my addiction components model (i.e., one from 1999 rather than my most recent 2005 formulation) to help inform item construction, I was obviously interested to see the scale’s formulated items. I have to admit that I had a lot of misgivings about the paper so I wrote a commentary on it that has just been published in the same journal (Frontiers in Public Health). More specifically, I noted in my paper that if an individual was genuinely addicted to searching online databases I would have expected to see all of my six criteria applied as follows:

• Salience – This occurs when searching internet databases 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 searching the internet they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with internet database searching).
• Mood modification – This refers to the subjective experiences that people report as a consequence of internet database searching and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’ when searching internet databases).
• Tolerance – This is the process whereby increasing amounts of time searching internet databases are required to achieve the former mood modifying effects. This basically means that for someone engaged in internet database searching, they gradually build up the amount of the time they spend searching internet databases every day.
• Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.), that occur when an individual is unable to search internet databases because they are ill, the internet is unavailable, or there is no Wi-Fi on holiday, etc.
• Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time searching internet databases.
• Relapse – This is the tendency for repeated reversions to earlier patterns of excessive internet database searching to recur and for even the most extreme patterns typical of the height of excessive internet database searching to be quickly restored after periods of control.

Of the 12 QISD items constructed in the new scale, very few appeared to have anything to do with addiction and/or dependence but this is most likely due to the fact that the authors also used data collected from 50 participants to inform their items and not just the criteria in the addiction components model. However, relying heavily on input from their participants resulted in a number of key features in addiction/dependence not even being assessed (i.e., no assessment of salience, mood modification, conflict, relapse or tolerance). A couple of items may peripherally assess withdrawal symptoms (e.g., ‘I will be upset if I cannot find an answer to a complex question through Internet search’) but not in any way that is directly associated with addiction or dependence. This may be because the authors’ conceptualization of ‘dependence’ was more akin to ‘over-reliance’ rather than traditional definitions of dependence.

While the QISD may be psychometrically robust I argued that it appears to have little face validity and does not appear to assess problematic engagement in internet database searching (irrespective of how addiction or dependence is defined). Based on the addiction components model, I concluded my paper by creating my own scale to assess internet search dependence based directly on the addiction components model and which I argued would have much greater face validity than any item currently found in the QISD:

• Internet database searching is the most important thing in my life.
• Conflicts have arisen between me and my family and/or my partner about the amount of time I spend searching internet databases.
• I engage in internet database searching as a way of changing my mood.
• Over time I have increased the amount of internet database searching I do in a day.
• If I am unable to engage in internet database searching I feel moody and irritable.
• If I cut down the amount of internet database searching I do, and then start again, I always end up searching internet databases as often as I did before.

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

Further reading

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

Andreassen, C.S., Pallesen, S., Griffiths, M.D. (2017). The relationship between excessive online social networking, narcissism, and self-esteem: Findings from a large national survey. Addictive Behaviors, 64, 287-293.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (pp. 61-75). New York: Academic Press.

Griffiths, M.D. (1999a). Internet addiction: Internet fuels other addictions. Student British Medical Journal, 7, 428-429.

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

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

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

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

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, in press.

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

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.

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.

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More mass debating: Compulsive sexual behaviour and the internet

The issue of sex addiction as a behavioural addiction has been hotly debated over the last decade. A recent contribution to this debate is a review by Shane Kraus and his colleagues in the latest issue of the journal Addiction that examined the empirical evidence base for classifying compulsive sexual behaviour (CSB) as a behavioural (i.e., non-substance) addiction. The review raised many important issues and highlighted many of the problems in the area including the problems in defining CSB, and the lack of robust data from many different perspectives (epidemiological, longitudinal, neuropsychological, neurobiological, genetic, etc.).

As my regular blog readers will know, I have carried out empirical research into a wide variety of different behavioural addictions (gambling, video gaming, internet use, exercise, sex, work, etc.) and have argued that some types of problematic sexual behaviour can be classed as sex addiction depending upon the definition of addiction used. I was invited by the editors of Addiction to write a commentary on the review and this has just been published in the same issue as the paper by Kraus and colleagues. This blog briefly looks at the issues in that review that I highlighted in my commentary.

For instance, there are a number of areas in Kraus et al.’s paper that were briefly mentioned without any critical evaluation. For instance, in the short section on co-occurring psychopathology and CSB, reference was made to studies claiming that 4%-20% of those with CSB also display disordered gambling behaviour. I pointed out that a very comprehensive review that I published with Dr. Steve Sussman and Nadra Lisha (in the journal Evaluation and the Health Professions) examining 11 different potentially addictive behaviours also highlighted studies claiming that sex addiction could co-occur with exercise addiction (8%-12%), work addiction (28%-34%), and shopping addiction (5%-31%). While it is entirely possible for an individual to be addicted to (say) cocaine and sex concurrently (because both behaviours can be carried out simultaneously), there is little face validity that an individual could have two or more co-occurring behavioural addictions because genuine behavioural addictions consume large amounts of time every single day. My own view is that it is almost impossible for someone to be genuinely addicted to (for example) both work and sex (unless the person’s work was as an actor/actress in the pornographic film industry).

The paper by Kraus et al also made a number of references to “excessive/problematic sexual behavior” and appeared to make the assumption that ‘excessive’ behaviour is bad (i.e., problematic).  While I agree that CSB is typically excessive, excessive sex in itself is not necessarily problematic. Preoccupation with any behaviour in relation to addiction obviously needs to take into account the context of the behaviour, as the context is far more important in defining addictive behaviour than the amount of the activity undertaken. As I have constantly argued, the fundamental difference between a healthy excessive enthusiasms and addictions is that healthy excessive enthusiasms add to life whereas addictions take away from them.

The paper also appeared to have an underlying assumption that empirical research from a neurobiological and genetic perspective should be treated more seriously than that from a psychological perspective. Whether problematic sexual behaviour is described as CSB, sex addiction and/or hypersexual disorder, there are thousands of psychological therapists around the world that treat such disorders. Consequently, clinical evidence from those that help and treat such individuals should be given greater credence by the psychiatric community.

Arguably the most important development in the field of CSB and sex addiction is how the internet is changing and facilitating CSB. This was not even mentioned until the concluding paragraph yet research into online sex addiction (while comprising a small empirical base) has existed since the late 1990s including sample sizes of up to almost 10,000 individuals. In fact, there have been a number of recent reviews of the empirical data concerning online sex addiction including its treatment including ones by myself in journals such as Addiction Research and Theory (in 2012) and Current Addiction Reports (in 2015). My review papers specifically outlined the many specific features of the Internet that may facilitate and stimulate addictive tendencies in relation to sexual behaviour (accessibility, affordability, anonymity, convenience, escape, disinhibition, etc.). The internet may also be facilitating behaviours that an individual would never imagine doing offline such as cybersexual stalking.

Finally, there is also the issue of why Internet Gaming Disorder was included in the DSM-5 (in Section 3 – ‘Emerging measures and models’) but sex addiction/hypersexual disorder was not, even though the empirical base for sex addiction is arguably on a par with IGD. One of the reasons might be that the term ‘sex addiction’ is often used (and arguably misused) by high profile celebrities as an excuse to justify their infidelity (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand), and is little more than 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 are bombarded with sexual advances from other individuals and have succumbed. But how many people would not do the same thing if they had the opportunity? Sex only becomes a problem (and is pathologised) when the person is found to have been unfaithful. Such examples arguably give sex addiction a ‘bad name’, and provides a good reason for those not wanting to include such behaviour in diagnostic psychiatry texts.

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

Further reading

Bocij, P., Griffiths, M.D., McFarlane, L. (2002). Cyberstalking: A new challenge for criminal law. Criminal Lawyer, 122, 3-5.

Cooper, A., Delmonico, D.L., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity, 6, 79-104.

Cooper, A., Delmonico, D.L., Griffin-Shelley, E., & Mathy, R.M. (2004). Online sexual activity: An examination of potentially problematic behaviors. Sexual Addiction and Compulsivity, 11, 129-143.

Cooper, A., Galbreath, N., Becker, M.A. (2004). Sex on the Internet: Furthering our understanding of men with online sexual problems. Psychology of Addictive Behaviors, 18, 223-230.

Cooper, A., Griffin-Shelley, E., Delmonico, D.L., Mathy, R.M. (2001). Online sexual problems: Assessment and predictive variables. Sexual Addiction and Compulsivity, 8, 267-285.

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

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. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.

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

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

Griffiths, M.D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the Internet and other issues. Addiction, 111, 2107-2109.

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.

Kraus, S., Voon, V., & Potenza, M. (2016). Should compulsive sexual behavior be considered an addiction? Addiction 111, 2097-2106.

Orzack M.H., & Ross C.J. (2000). Should virtual sex be treated like other sex addictions? Sexual Addiction and Compulsivity, 7, 113-125.

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.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.