Reading by example: The books that inspired my career

This Christmas I managed to do a lot of book reading (most of it being David Bowie-related) and my favourite read was John O’Connell’s Bowie’s Books: The Hundred Literary Heroes Who Changed His Life (which If I’m nit-picking should actually be the 98 heroes because George Orwell and Anthony Burgess make two appearances each on the list), followed by Will Brooker’s Why Bowie Matters (a book I wish I had wrote because it was written by a Professor of Film and Cultural Studies and is a loose account of an academic spending a whole year trying to live like David Bowie as a piece of research). I also love lists so I thought I’d kick off the New Year with a list of the books that have shaped my academic life. This list was first published by The Psychologist (in 2018) but this blog may give my list a wider readership.

Excessive Appetites: A Psychological View of the Addictions (by Jim Orford)

One of the most influential books on my whole career is Jim Orford’s seminal book Excessive Appetites that explored many different behavioural addictions including gambling, sex, and eating (i.e., addictions that don’t involve the ingestion of psychoactive substances). Jim Orford’s books are always worth a read and he writes in an engaging style that I have always admired. It was by chance that I did my PhD at the University of Exeter (1987-1990) where Orford was working at the time and since 2005 we have published many co-authored papers together. While we can agree to disagree on some aspects of how and why people become addicted, Jim will continue to be remembered as a pioneer in the field of behavioural addiction.

The Psychology of Gambling (by Michael Walker)

If there’s one book I’d wish I had written myself, it is this one. I did my PhD on slot machine addiction in adolescence but this book was published shortly after I’d finished and beautifully summarises all the main theories and perspectives on gambling psychology. My PhD would have been a whole lot easier if this book had been published when I first started my research career! I got to know Michael quite well before his untimely death in December 2009 (and he was external PhD examiner to some of my PhD students), and one of my enduring images of him was walking around at gambling conferences with his book clutched in his hand. Some of my colleagues found that a little strange but if I’d have written a book that good I’d have it with me at such events all the time!

Motivational Interviewing: Preparing People for Change (by William R. Miller and Stephen Rollnick)

I reviewed this book for the British Journal of Clinical Psychology (BJCP) back in the early 1990s and concluded by saying that it is a book that should be read by all therapists because its content can be applied to nearly all clinical situations and not just to those individuals with addictive behaviour problems. Motivational interviewing (MI) borrows strategies from cognitive therapy, client-centred counselling, systems theory, and the social psychology of persuasion, and the underlying theme of the book is the issue of ambivalence, and how the therapist can use MI to resolve it and allow the client to build commitment and reach a decision to change. In my most recent research I’ve used the basic tenets of MI in designing personalised messages to give to gamblers while they are gambling online in real time. I’ve now come to the conclusion 25 years after writing my BJCP review that anyone interested in enabling behavioural change should apply the tenets in this book to their work.

The Myth of Addiction (by John B. Davies)

Even though this book was published back in 1992, I still tell my current students that this is a ‘must read’ book. Davies takes a much researched area of social psychology (i.e., attribution theory) and applies it to addiction. The basic message of the book is that people take drugs because they want to and not because they are physiologically addicted. The whole book is written in a non-technical manner and is highly readable and thought provoking. I often use Davies’ term ‘functional attribution’ from this book in my teaching and writings on sex addiction, and apply it to celebrities who use the excuse of ‘sex addiction’ to justify their infidelities.

Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices (by Anil Aggrawal)

Anyone that reads my blog will know that when it comes to the more bizarre side of sexual activity, my ‘go to’ book is Dr. Aggrawal’s book on unusual sexual practices. Others in the sexology field often look down their noses at this book but it is both enjoyable and informative and the kind of book that once you start reading you find it hard to put down again. A lot of academic books on sexual behaviour can be boring and/or impenetrable but this one is the polar opposite. The book also kick-started some of my own recently published research on sexual fetishes and paraphilias.

Small World (by David Lodge)

During my PhD, I remember watching the 1988 adaptation of David Lodge’s novel Small World. At the time, I had never heard of David Lodge but I went out and bought the book and was totally hooked. I then discovered that Small World was the second part of a ‘campus trilogy’ (preceded by Changing Places and followed by Nice Work). Since then I have bought every novel Lodge has ever published and he’s my favourite fiction writer (and I’ve bought and read some of his academic books on literary criticism). I love campus novels and through Lodge and devoured other university-based novels (including Malcolm Bradbury’s The History Man, Howard Jacobson’s Coming from Behind, and Ann Oakley’s The Men’s Room among my favourites).

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

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Brooker, W. (2019) Why Bowie Matters. London: William Collins.

Davies J. B. (1992). The Myth of Addiction. Reading: Harwood Academic Publishers.

Griffiths, M.D. (2018). My shelfie. The Psychologist: Bulletin of the British Psychological Society, 31, 70.

Lodge, D. (1984). Small World. London: Secker & Warburg.

Miller, W. R., & Rollnick, S. (1991). Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press.

O’Connell, J. (2019). Bowie’s Books: The Hundred Literary Heroes Who Changed His Life. London: Bloomsbury.

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

“Just one more thing”: The psychology of ‘Columbo’

My favourite TV detective has always been Columbo (played by Peter Falk). I have watched every single one of the 69 episodes (as my family will attest) many times. While I am working, I will often have Columbo on in the background in the way that other people have music on in the background (although I do the latter as well). For those reading this that have not come across Columbo, here is a brief synopsis from Wikiquote:

“Columbo (1968, 1971-1978, 1989-2003) was an American crime fiction television show about Lieutenant Columbo, a homicide detective with the Los Angeles Police Department. He uses his deferential and absent-minded persona to lull criminal suspects into a false sense of security, by harassing and pestering suspects non-stop – without letting them know that they’re suspects – under the pretense that he’s simply being a pesky detective, in order to spy on them and agitate them into giving up clues”.

I have asked myself many times why I love the iconic show so much and it’s hard to put my finger on any single reason. One of the things I love about the show is that almost all the episodes are a ‘reverse whodunit’ (often referred to as an ‘open mystery’) in which the viewer knows the identity of the murderer(s) and we watch to see how Lt. Columbo uncovers who the killer or killers are. (I say “almost all” because there are actually a few episodes that are more typical ‘whodunits’ such as 1976’s ‘Last Salute To The Commodore’, 1992’s ‘No Time To Die’ [involving a kidnapping rather than a murder] and 1994’s ‘Undercover’). Another aspect I love is the inherent contradictions in Lt. Columbo’s day-to-day behaviour. His dishevelled clothing (the infamous beaten-up raincoat), his apparently bumbling absent-minded nature, and his habit of going off-topic in conversations, but knowing that he is actually one of the most astute and clever detectives that you are ever likely to meet (he would no-doubt fit the description of the stereotypical ‘absent-minded professor’). As a psychologist I find him fascinating. As an article about Columbo on the Cult TV Lounge rightly notes:

“The emphasis is on the psychological duel between detective and suspect, with (mercifully) no interest in social commentary and few concessions to the ‘realism’ that would become more and more of a fetish in TV cop shows during the course of the 70s. This is pure entertainment and it’s all the better for it”.

And finally, it is Lt. Columbo’s brilliant trademark ‘false exits’ that wrongfoot all the murderers. After most informal interrogations with the murderer, Columbo leaves the scene, only to return a few seconds later with the opening gambit of “there’s just one more thing” (or a variant of the phrase) only for it to be the most important question that he “forgot to ask”. As an obituary at the In The Dark website on Peter Falk noted:

“The more trivial the “thing” is, the more damning it proves. As an application of psychology, it’s a superb tactic and it slowly but surely grinds down the criminal’s resistance. Often the murderer’s exasperation at Columbo’s relentless badgering leads to rash actions and errors; the second murder, if there is one, is never as carefully planned as the first”.

As the selected (emboldened) quotes above show, psychology is an integral part of Columbo’s appeal. I was also surprised to find that clinical psychologists and forensic psychologists have used Lt. Columbo’s modus operandi in their day-to-day work. (In fact, even some writers claim that if you want to be a better writer you should watch Columbo according to an article by Shahan Mufti in the New York Times; also, a number of marketing gurus claim that Lt. Columbo can teach marketers a thing or two – check out ‘10 things marketeers can learn from Columbo’). For instance, in an article on motivational interviewing (MI) via the Australian Mental Health Academy describe the ‘Columbo approach’:

“Proponents of motivational interviewing owe a debt of gratitude to the 1970s television series Columbo…[Columbo] was a master of the skill of ‘deploying discrepancies’, and MI therapists/practitioners can use the same skill to get clients to help them make sense of their (the clients’) discrepancies. With the Columbo approach, an interviewer makes a curious enquiry about discrepant behaviours without being judgmental or blaming. In a non-confrontational manner, information that is contradictory is juxtaposed, allowing the therapist to address discrepancies between what clients say and their behaviour without evoking defensiveness or resistance. Wherever possible when deploying discrepancies, practitioners are encouraged to end the reflection on the side of change, as clients are more likely to elaborate on the last part of the statements”

The article then goes on to explicitly describe specific MI interventions using the ‘Columbo approach’. Another online article by Greg Lhamon (‘A simple trick to make a powerful last impression’) describes the ‘Columbo Technique’. Here is an abridged version:

“One way in which you can leave someone with a powerful last impression is to use…“the Columbo Technique”…named after the lovable yet shrewd TV detective from the 1970s…He was unassuming and appeared almost absent-minded as he questioned a murder suspect. Yet his seemingly random line of questioning was the process by which he built an airtight case against the suspect. At the conclusion of every interview, he did something unique: he’d thank the suspect profusely, step toward the door, stop, and then turn back, and say, “Oh, just one more thing.” Then he’d ask one last question, a particularly damning question that let the suspect know that Lieutenant Columbo was onto him. Like every form of good communication, sincerity is critical. It cannot be contrived. The goal is simply to make a strong, memorable point, not to manipulate someone. The process is simple: (1) hold back a critical piece of information and reserve it for the end of the meeting, (2) right before you part company, share the information or ask a question, and (3) enjoy the response you receive”.

A 2009 article in the American Bar Association Journal reported that the best way to interrogate a suspect is to ‘Think Columbo’. The advice given was that police should focus on what suspects say rather than their behaviour (such as fidgeting, sweating, and averting eyes during an interview). After reviewing interrogation tapes, Professor Ray Bull, a British forensic psychologist told the Times newspaper that British police use an investigative interviewing technique:

“These interviews sound much more like a chat in a bar. It’s a lot like the old Columbo show, you know, where he pretends to be an idiot but he’s gathered a lot of evidence.”

The ABA article also included comments from American psychologist Kevin Colwell, who said that suspects that lie in police interviews “often prepare a script that doesn’t have much detail”. Colwell recommended using interview techniques where the individual undergoing questioning should talk about the event in question more than once “adding details in retelling the event about things such as sounds and smells” and asking the person “to recall the event in reverse” and that:

“Those who tell the truth tend to add 20% to 30% more external detail than do those who are lying. Those who are adept at lying may start to feel more strain if the interviewer introduces evidence throughout the questioning that has been previously uncovered. Detective Columbo, it turns out, was not just made for TV”.

Another reason I love Columbo because a number of episodes featured psychologists and/or psychiatrists as the killer, most of who used their psychological expertise to carry out an ingenious murder. This included the episodes ‘Prescription Murder’ (1968 – the first ever episode; Dr. Ray Flemming who uses his high intelligence rather than his psychiatric expertise to murder his wife), ‘Double Exposure’ (1973; Dr. Bart Kepple, a consumer psychologist who uses subliminal advertising to lure his victim to be killed), ‘A Deadly State Of Mind’ (1975; Dr. Marcus Collier, a psychiatrist who uses hypnosis to make his victim jump from a high rise apartment), ‘How To Dial A Murder’ (1978; Dr. Eric Mason, a behavioural psychologist who uses classical conditioning to train his dogs to kill his victim), and ‘Sex And The Married Detective’ (1998; Dr. Joan Allenby, a sex therapist who uses her knowledge of psychosexual roleplay to ensnare and kill her lover). In one episode (‘How To Dial A Murder’), Columbo and the psychologist Dr. Eric Mason have an interesting exchange:

Dr. Eric Mason: You’re a fascinating man, Lieutenant. Columbo: To a psychologist, sir? Dr. Eric Mason: You pass yourself off as a puppy in a raincoat happily running around the yard digging holes all up in the garden, only you’re laying a mine field and wagging your tail.

As an ex-Professor of Gambling Studies, another aspect that I have noticed is how many episodes of Columbo feature gamblers and gambling that are often integral to the storyline. Gambling is a key feature in the episodes ‘Double Shock’ (1973; the murderer Norman Paris, a banker, is featured at a Las Vegas casino running up gambling debts), ‘A Friend in Deed’ (1974; the murderer Mark Halperin, a deputy police commissioner, is shown in his opening scene to be a regular casino gambler), ‘Uneasy Lies The Crown’ (1990; the murderer, Dr. Wesley Corman is a dentist and a compulsive gambler), ‘Death Hits The Jackpot’ (1991; photographer and murder victim Freddy Brower wins a $30 million on the lottery and is killed by his uncle Leon Lamarr), ‘A Bird In The Hand’ (1992; would-be murderer Harold McCain, a compulsive gambler tries to murder his millionaire uncle, owner of a US football team), ‘All in The Game’ (1993; murder victim Nick Franco is a playboy and high stakes poker player killed by his lover Laura Staton), and ‘Strange Bedfellows’ (1995; Randy McVeigh the murder victim owes money for gambling debts to the Mafia and is killed by his brother Graham who has ‘inherited’ his brother’s debt).

In another episode (‘Troubled Waters’, 1975), it turns out that the killer (Hayden Danzinger, an autocar executive) is also a regular casino gambler but this only comes to light late in the episode when Lt. Columbo talks to his wife (Sylvia Danzinger). Here we learn that Lt. Columbo thinks about slot machines:

Columbo: You see that fellow over there playing the slot machines? Waste of money. I’ve played it 44 times. I won once right at the beginning and I never won again. Sylvia Danzinger: You can’t beat ‘em. I don’t even try. Columbo: You’re not a gambler? Sylvia Danzinger: No, I prefer more quiet activities. Columbo: That’s funny. I was under the impression you and your husband went to Las Vegas quite a few times. Sylvia Danzinger: Oh, no. Hayden goes often but without me. I wouldn’t be caught dead there.

I’ve often wondered if gambling was an important issue (positive or negative) for Peter Falk in his private life, because when he wasn’t playing Lt. Columbo, it wasn’t unusual for him to be in gambling-related acting roles. Most notably, he played an ageing bookmaker Vinnie in the 1988 film Money Kings (also known under the title Vig, a film about the illegal world of gambling), and the 1988 film Pronto he played Harry Arno, a sports bookmaker who stole money from the local mafia boss Jimmy Capatorto. He also played the poker player Waller in a 1960 episode of Have Gun – Will Travel (‘Poker Fiend‘), and in the 1970 film Husbands he played Archie Black, one of three men undergoing mid-life crises following the death of their friend who then who all go to Europe to gamble, drink, and womanise.

If you’ve got this far, I’ll just leave you with the answers to a couple of my favourite Columbo trivia questions. The most asked question concerning Lt. Columbo (like Inspector Morse) is what was his first name. (When asked the same question in the series itself, Columbo would answer ‘Lieutenant’!). Lt. Columbo never once revealed his first name verbally in the series but did once flash his police badge in an early episode (‘Dead Weight’; Episode 3, Series 1) and accidentally revealed his name was Frank. The second most asked question is how Peter Falk lost his eye. Falk had his eye removed at the age of three years (due to cancer) and had a glass eye for the rest of his life. Although Falk had a glass eye, fans debated for years whether Lt. Columbo had only one eye. The answer was revealed in the 25th anniversary episode (‘A Trace of Murder’) when Lt. Columbo asked the murderer (Patrick Kinsley, a forensic expert) to look at something with him because “three eyes are better than one”!

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

Further reading

Burns, S. (2016). The Columbo Episode Guide. Located at: http://www.columbo-site.freeuk.com/episode.htm

Changing Minds (2013). The Columbo Technique. Located at: http://changingminds.org/techniques/questioning/columbo_technique.htm

Dawidziak, M. (1989). The Columbo Phile. Mysterious Press.

D For Doom (2015). Columbo, Season 1 (1971). Cult TV Lounge, July 3. Located at: http://cult-tv-lounge.blogspot.co.uk/2015/07/columbo-season-one-1971.html

Haynes, N. (2012). Guide to TV detectives: No.1. The Guardian, January 23. Located at: https://www.theguardian.com/tv-and-radio/tvandradioblog/2012/jan/23/natalie-haynes-detectives-columbo

Henley, J. (2013). 10 things marketeers can learn from Columbo – yes, Columbo. Rock The Deadline, November 24. Located at: http://rockthedeadline.com/blog/content-marketing/10-things-marketers-can-learn-from-columbo-yes-columbo/

Mental Health Academy (2015). Principles and techniques of motivational interviewing. January 12. Located at: http://www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/

Mufti, S. (2013). Want to write better? Watch Columbo. New York Times (The 6^th Floor), September 25. Located at: http://6thfloor.blogs.nytimes.com/2013/09/25/want-to-write-better-watch-columbo/?_r=2

Telescoper (2011). In memorium: Peter Falk (1927-2011). In The Dark, https://telescoper.wordpress.com/2011/06/25/in-memoriam-peter-falk-1927-2011/

Weiss, D.C. (2009). The best way to interrogate: Think Columbo. American Bar Association, May 12. Located at: http://www.abajournal.com/news/article/the_best_way_to_interrogate_think_columbo/

Wikipedia (2016). Columbo. Located at: https://en.wikipedia.org/wiki/Columbo

Wikipedia (2016). List of Columbo episodes. Located at: https://en.wikipedia.org/wiki/List_of_Columbo_episodes

Wikipedia (2016). Peter Falk. Located at: https://en.wikipedia.org/wiki/Peter_Falk

Wikiquote (2016). Columbo. Located at: https://en.wikiquote.org/wiki/Columbo

Cured meets: Treating addictive behaviours

Addiction is a highly prevalent problem within today’s society and there is a lot of time and many spent in trying to prevent and treat the behaviour. There has also been a move towards getting addicts motivated to want to change their behaviour. The most influential model worldwide is probably the ‘stages of change’ model by Dr. James Prochaska and Dr, Carlo Di Clemente that identifies an individual’s ‘readiness for change’ and tries to get a person to a position where they are highly motivated to change their behaviour. The individual stages of this model are:

• Precontemplation – This is where the person unaware of the consequences of his or her own behaviour and no change in behaviour is foreseeable.
• Contemplation – This is where the person aware problem exists and is contemplating change.
• Preparation – This is where the person has decided to change in the near future (e.g., New Year resolution).
• Action – This is where the person effects change (e.g., gets rid of all association items related to the behaviour).
• Maintenance – This is where the person consolidates behaviour change over time.
• Relapse – This where the person reverts to a former behaviour pattern (e.g., contemplation, preparation).

People can stay in one stage for a long time and it is also possible for unassisted change such “maturing out” or “spontaneous remission”. Various techniques can be used to help people prepare for readiness include motivational techniques, behavioural self-training, skills training, stress management training, anger management training, relaxation training, aerobic exercise, relapse prevention, and lifestyle modification. The goal of treatment can be either abstinence or simply to cut down.

The intervention and treatment options for the treatment of addiction include, but are not limited to counselling/psychotherapies, behavioural therapies, cognitive-behavioural therapies, self-help therapies, pharmacotherapies, residential therapies, minimal interventions and combinations of these (i.e., multi-modal treatment packages). The most important of these are outlined below.

Pharmacotherapy: Pharmacological interventions basically consist of addicts being given a drug to help overcome their addiction. These are mainly given to those people with chemical addictions (e.g., nicotine, alcohol, heroin, etc.) but are increasingly being used for those with behavioural addictions (e.g., gambling, sex, work, exercise, etc.). For instance, some drugs produce an unpleasant reaction when used in combination with the drug of dependence, replacing the positive effects of the drug of dependence with a negative reaction. For instance, alcoholics are sometimes prescribed disulfiram (more commonly known as Antabuse), that when combined with alcohol may produce nausea and vomiting. Other common therapies include methadone and the use of opioid antagonists (such as nalaxone or naltrexene) for heroin addiction. The methadone prevents withdrawal symptoms, block the effects of heroin use, and decreases craving. The main criticism of all these treatments is that although the symptoms may be being treated, the underlying reasons for the addictions may be being ignored. On a more pragmatic level, what happens when the drug is taken away? Often, the addicts return to their addiction if this is the only method of treatment used.

Behavioural therapy: Behavioural therapies are based on the view that addiction is a learned maladaptive behaviour and can therefore be ‘unlearned’. These have mainly been based on the classical conditioning paradigm and include aversion therapy, in vivo desensitisation, imaginal desensitisation, systematic desensitisation, relaxation therapy, covert sensitisation, and satiation therapy. All of these therapies focus on cue exposure, and relapse triggers (like the sight and smell of alcohol/drugs, walking through a neighbourhood where casinos are abundant, pay day, arguments, pressure, etc.). The theory is that through repeated exposure to ‘relapse triggers’ in the absence of the addiction, the addict learns to stay addiction free in high-risk situations. It could be argued that if the addiction is caused by some underlying psychological problem, (rather than a learned maladaptive behaviour), then behavioural therapy would at best only eliminate the behaviour but not the problem. This therefore means that the addictive behaviour may well have been curtailed but the problem is still there so the person will perhaps engage in a different addictive behaviour instead.

Cognitive-behavioural therapy: A more recent development in the treatment of addictive behaviours is the use of cognitive-behavioural therapies (CBT). There are many different CBT approaches that have been used in the treatment of addictive behaviours including rational emotive therapy, motivational interviewing, and relapse prevention. The techniques assume that addiction is a means of coping with difficult situations, dysphoric mood, and peer pressure. Treatment aims to help addicts recognise high-risk situations and either avoid or cope with them without use of the addictive behaviour. In relapse prevention, the therapist helps to identify situations that present a risk for relapse (both intrapersonal and interpersonal). Relapse prevention provides the addict with techniques to learn how to cope with temptation (positive self statements, decision review, and distraction activities), coupled with the use of covert modelling (i.e., practicing coping skills in one’s imagination). It also provides skills for coping with lapses (by redefining what is happening), and utilizes graded practice (a desensitization technique where addicts encounter real life situations slowly). Overall, CBT approaches are better researched than the other psychological methods in addiction but are probably no more effective (Luty, 2003).

Psychotherapy: Psychotherapy can include everything from Freudian psychoanalysis and transactional analysis, to more recent innovations like drama therapy, family therapy and minimalist intervention strategies. The therapy can take place as an individual, as a couple, as a family, as a group and is basically viewed as a ‘talking cure’ consisting of regular sessions with a psychotherapist over a period of time. Most psychotherapies view maladaptive behaviour as the symptom of other underlying problems. Psychotherapy often is very eclectic by trying to meet the needs of the individual and helping the addict develop coping strategies. If the problem is resolved, the addiction should disappear. In some ways, this is the therapeutic opposite of pharmacotherapy and behavioural therapy (which treats the symptoms rather than the underlying cause). There has been little evaluation of its effectiveness although most addicts go through at least some form of counselling during the treatment process.

Self-help therapy: The most popular self-help therapy worldwide is the Minnesota Model 12-Step Programme (e.g., Alcoholics Anonymous, Gamblers Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sexaholics Anonymous, etc.). This treatment programme uses a group therapy technique and uses only ex-addicts as helpers. Addicts attending 12-Step groups involves them accepting personal responsibility and views the behaviour as an addiction that cannot be cured but merely arrested. To some it becomes a way of life both spiritually and socially and compared with almost all other treatments it is especially cost-effective (even if other treatments have greater success rates) as the organization makes no financial demands on members or the community. For the therapy to work, the 12-Step Programme asserts that the addict must come to them voluntarily and must really want to stop engaging in their addictive behaviour. Further to this, they are only allowed to join once they have reached “rock bottom”. To date there has been little systematic study of 12-Step groups but drop out rates are very high (typically 80-90%). There are a number of problems preventing evaluation, particularly anonymity, sample bias, and what the criterion for success is. The empirical evidence suggests that self-help support groups’ complement formal treatment options and can support standardized psychosocial interventions.

When examining all the literature on the treatment of addiction, there are a number of key conclusions that can be drawn. These include that: (i) treatment must be readily available, (ii) no single treatment is appropriate for all individuals., (iii) it is better for an addict to be treated than not to be treated, (iv) it does not seem to matter which treatment an addict engages in as no single treatment has been shown to be demonstrably better than any other, (v) a variety of treatments simultaneously appear to be beneficial to the addict, (vi) individual needs of the addict have to be met (i.e., the treatment should be fitted to the addict including being gender-specific and culture-specific), (vi) clients with co-existing addiction disorders should receive services that are integrated, (vii) remaining in treatment for an adequate period of time is critical for treatment effectiveness, (viii) medications are an important element of treatment for many patients, especially when combined with counselling and other behavioural therapies, (ix) recovery from addiction can be a long-term process and frequently requires multiple episodes of treatment, (x) there is a direct association between the length of time spent in treatment and positive outcomes, and (xi) the duration of treatment interventions is determined by individual needs, and there are no pre-set limits to the duration of treatment.

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

Further reading

Griffiths, M.D. (1996). Pathological gambling and its treatment. British Journal of Clinical Psychology, 35, 477-479.

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

Griffiths, M.D. & H.F. MacDonald (1999). Counselling in the treatment of pathological gambling: An overview. British Journal of Guidance and Counselling, 27, 179-190.

Hayer, T. & Griffiths, M.D. (2015). The prevention and treatment of problem gambling in adolescence. In T.P. Gullotta & G. Adams (Eds). Handbook of Adolescent Behavioral Problems: Evidence-based Approaches to Prevention and Treatment (Second Edition) (pp. 539-558). New York: Kluwer.

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

Luty, J. (2003). What works in drug addiction? Advances in Psychiatric Treatment, 9, 280–288.

National Institute on Drug Abuse (1999). Principles of drug addiction treatment: A research-based guide. NIDA.

Potenza, M. & Griffiths, M.D. (2004). Prevention efforts and the role of the clinician. In J.E. Grant & M. N. Potenza (Eds.), Pathological Gambling: A Clinical Guide To Treatment (pp. 145-157). Washington DC: American Psychiatric Publishing Inc.

Prochaska, J.O. and DiClemente, C.C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Melbourne, Florida: Krieger Publishing Company

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

United Nations Office on Drugs and Crime/World Health Organization (2008). Principles of Drug Dependence Treatment: Discussion paper. UN/WHO.