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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.

shutterstock_cybersex

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.

 

Net losses: Another look at problematic online gaming

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

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

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

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

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

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

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

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

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

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

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

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

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

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

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

I love view: Can Google Glass be addictive?

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Net losses: Internet abuse and addiction in the workplace

The following article is a much extended version of an article that was originally published by The Conversation under the title ‘Tweets and cybersex: Workplace web use is a minefield’

A number of market research reports have indicated that many office employees in the UK spend at least one hour of their day at work on various non-work activities (e.g., booking holidays, shopping online, posting messages on social networking sites, playing online games, etc.) and costs businesses millions of pounds a year. These findings highlight that internet abuse is a serious cause for concern – particularly to employers. Furthermore, the long-term effects of internet abuse may have more far-reaching effects for the company that internet abusers work for than the individuals themselves. Abuse also suggests that there may not necessarily be any negative effects for the user other than a decrease in work productivity.

Back in the early 2000s (and using some of Kimberley Young’s work on types of internet addiction) I developed a typology of internet abusers. This included cybersexual Internet abuse, online friendship/relationship abuse, internet activity abuse, online information abuse, criminal internet abuse, and miscellaneous Internet abuse:

  • Cybersexual Internet abuse: This involves the abuse of adult websites for cybersex and cyberporn during work hours. Such behaviours include the reading of online pornographic magazines, the watching of pornographic videos and/or webcams, or the participating in online sexual discussion groups, forums or instant chat facilities
  • Online friendship/relationship abuse: This involves the conducting of an online friendship and/or relationship during work hours. Such a category could also include the use of e-mailing friends, posting messages to friends on social networking sites (e.g., on Facebook, Twitter, etc.), and/or engaging in discussion groups, as well as maintenance of online emotional relationships. Such people may also abuse the Internet by using it to explore gender and identity roles by swapping gender or creating other personas and forming online relationships or engaging in cybersex.
  • Internet activity abuse: This involves the use of the internet during work hours in which other non-work related activities are done (e.g., online gambling, online shopping, online travel booking, online video gaming in massively multiplier games, online day-trading, online casual gaming via social network sites, etc.). This appears to be one of the most common forms of Internet abuse in the workplace.
  • Online information abuse: This involves the abuse of internet search engines and databases (e.g., Googling online for hours, constantly checking Twitter account, etc.). Typically, this involves individuals who search for work-related information on databases etc. but who end up wasting hours of time with little relevant information gathered. This may be deliberate work-avoidance but may also be accidental and/or non-intentional. It may also involve people who seek out general educational information, information for self-help/diagnosis (including online therapy) and/or scientific research for non-work purposes.
  • Criminal Internet abuse: This involves the seeking out individuals who then become victims of sexually-related Internet crime (e.g., online sexual harassment, online trolling, cyberstalking, paedophilic “grooming” of children). The fact that these types of abuse involve criminal acts may have severe implications for employers.
  • Miscellaneous Internet abuse: This involves any activity not found in the above categories such as the digital manipulation of images on the Internet for entertainment and/or masturbatory purposes (e.g., creating celebrity fake photographs where heads of famous people are superimposed onto someone else’s naked body).

There are many factors that make Internet abuse in the workplace seductive. It is clear from research in the area of computer-mediated communication that virtual environments have the potential to provide short-term comfort, excitement, and/or distraction. These provide compelling reasons as to why employees may engage in non-work related internet use. There are also other reasons (opportunity, access, affordability, anonymity, convenience, escape, disinhibition, social acceptance, and longer working hours):

  • Opportunity and access: Obvious pre-cursors to potential Internet abuse includes both opportunity and access to the Internet. Clearly, the internet is now commonplace and widespread, and is almost integral to almost all office workplace environments. Given that prevalence of undesirable behaviours is strongly correlated with increased access to the activity, it is not surprising that the development of internet abuse appears to be increasing across the population. Research into other socially acceptable but potentially problematic behaviours (drinking alcohol, gambling etc.) has demonstrated that increased accessibility leads to increased uptake (i.e., regular use) and that this eventually leads to an increase in problems – although the increase may not be proportional.
  • Affordability: Given the wide accessibility of the internet, it is now becoming cheaper and cheaper to use the online services on offer. Furthermore, for almost all employees, Internet access is totally free of charge and the only costs will be time and the financial costs of some particular activities (e.g., online sexual services, online gambling etc.).
  • Anonymity: The anonymity of the Internet allows users to privately engage in their behaviours of choice in the belief that the fear of being caught by their employer is minimal. This anonymity may also provide the user with a greater sense of perceived control over the content, tone, and nature of their online experiences. The anonymity of the Internet often facilitates more honest and open communication with other users and can be an important factor in the development of online relationships that may begin in the workplace. Anonymity may also increase feelings of comfort since there is a decreased ability to look for, and thus detect, signs of insincerity, disapproval, or judgment in facial expression, as would be typical in face-to-face interactions.
  • Convenience: Interactive online applications such as e-mail, social media, chat rooms, online forums, or role-playing games provide convenient mediums to meet others without having to leave one’s work desk. Online abuse will usually occur in the familiar and comfortable environment of home or workplace thus reducing the feeling of risk and allowing even more adventurous behaviours.
  • Escape: For some, the primary reinforcement of particular kinds of internet abuse (e.g., to engage in an online affair and/or cybersex) is the sexual gratification they experience online. In the case of behaviours like cybersex and online gambling, the experiences online may be reinforced through a subjectively and/or objectively experienced ‘high’. The pursuit of mood-modifying experiences is characteristic of addictions. The mood-modifying experience has the potential to provide an emotional or mental escape and further serves to reinforce the behaviour. Abusive and/or excessive involvement in this escapist activity may lead to problems (e.g., online addictions). Online behaviour can provide a potent escape from the stresses and strains of real life. These activities fall on the continuum from life enhancing to pathological and addictive.
  • Disinhibition: Disinhibition is clearly one of the internet’s key appeals as there is little doubt that the Internet makes people less inhibited. Online users appear to open up more quickly online and reveal themselves emotionally much faster than in the offline world. What might take months or years in an offline relationship may only takes days or weeks online. As a number of researchers have pointed out, the perception of trust, intimacy and acceptance has the potential to encourage online users to use these relationships as a primary source of companionship and comfort.
  • Social acceptability:The social acceptability of online interaction is another factor to consider in this context. What is really interesting is how the perception of online activity has changed over the last 15 years (e.g., the ‘nerdish’ image of the Internet is almost obsolete). It may also be a sign of increased acceptance as young children and adolescents are exposed to technology earlier and so become used to socializing using computers as tools. For instance, laying the foundations for an online relationship in this way has become far more socially acceptable and will continue to be so. Most of these people are not societal misfits as is often claimed – they are simply using the technology as another tool in their social armory.
  • Longer working hours: All over the world, people are working longer hours and it is perhaps unsurprising that many of life’s activities can be performed from the workplace Internet. Take, for example, the case of a single individual looking for a relationship. For these people, the Internet at work may be ideal. Dating via the desktop may be a sensible option for workaholic professionals. It is effectively a whole new electronic “singles bar” which because of its text-based nature breaks down physical prejudices. For others, internet interaction takes away the social isolation that we can all sometimes feel. There are no boundaries of geography, class or nationality. It opens up a whole new sphere of relationship-forming.

Being able to spot someone who is an Internet abuser can be very difficult. However, there are some practical steps that employers can be taken to help minimize the potential problem.

  • Take the issue of internet abuse seriously. Internet abuse and addiction in all their varieties are only just being considered as potentially serious occupational issues. Managers, in conjunction with Personnel Departments need to ensure they are aware of the issues involved and the potential risks it can bring to both their employees and the whole organization. They also need to be aware that for employees who deal with finances, some forms of Internet abuse (e.g., Internet gambling), the consequences for the company can be very great.
  • Raise awareness of internet abuse issues at work. This can be done through e-mail circulation, leaflets, and posters on general notice boards. Some countries will have national and/or local agencies (e.g., technology councils, health and safety organizations etc.) that can supply useful educational literature (including posters). Telephone numbers for these organizations can usually be found in most telephone directories.
  • Ask employees to be vigilant. Internet abuse at work can have serious repercussions not only for the individual but also for those employees who befriend Internet abusers, and the organization itself. Fellow staff members need to know the basic signs and symptoms of Internet abuse. Employee behaviours such as continual use the Internet for non-work purposes might be indicative of an Internet abuse problem.
  • Monitor internet use of staff that may be having problems. Those staff members with an internet-related problem are likely to spend great amounts of time engaged in non-work activities on the Internet. Should an employer suspect such a person, they should get the company’s I.T. specialists to look at their Internet surfing history as the computer’s hard disc will have information about everything they have ever accessed.
  • Check internet “bookmarks” of staff. In some jurisdictions across the world, employers can legally access the e-mails and Internet content of their employees. One of the simplest checks is to simply look at an employee’s list of “bookmarked” websites. If they are spending a lot of employment time engaged in non-work activities, many bookmarks will be completely non-work related (e.g., online dating agencies, gambling sites).
  • Develop an “Internet Abuse At Work” policy. Many organizations have policies for behaviours such as smoking or drinking alcohol. Employers should develop their own internet abuse policies via liaison between Personnel Services and local technology councils and/or health and safety executives.
  • Give support to identified problem users. Most large organizations have counselling services and other forms of support for employees who find themselves in difficulties. In some (but not all) situations, problems associated with internet use need to be treated sympathetically (and like other more bona fide problems such as alcoholism). Employee support services must also be educated about the potential problems of internet abuse in the workplace.

Internet abuse can clearly be a hidden activity and the growing availability of internet facilities in the workplace is making it easier for abuse to occur in lots of different forms. Thankfully, it would appear that for most people internet abuse is not a serious individual problem although for large companies, small levels of internet abuse multiplied across the workforce raises serious issues about work productivity. For those whose internet abuse starts to become more of a problem, it can affect many levels including the individual, their work colleagues, and the organization itself.

Managers clearly need to have their awareness of this issue raised, and once this has happened, they need to raise awareness of the issue among the work force. Furthermore, employers need to let employees know exactly which behaviours on the Internet are reasonable (e.g., the occasional e-mail to a friend) and those that are unacceptable (e.g., online gaming, cybersex etc.). Internet abuse has the potential to be a social issue, a health issue and an occupational issue and needs to be taken seriously by all those employers who utilize the Internet in their day-to-day business.

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

Further reading

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (2002). Internet gambling in the workplace. In M. Anandarajan & C. Simmers (Eds.). Managing Web Usage in the Workplace: A Social, Ethical and Legal Perspective (pp. 148-167). Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D. (2002). Occupational health issues concerning Internet use in the workplace. Work and Stress, 16, 283-287.

Griffiths, M.D. (2003). Internet abuse in the workplace – Issues and concerns for employers and employment counselors. Journal of Employment Counseling, 40, 87-96.

Griffiths, M.D. (2004). Internet abuse and addiction in the workplace – Issues and concerns for employers. In M. Anandarajan (Eds.). Personal Web Usage in the Workplace: A Guide to Effective Human Resource Management (pp. 230-245).Hershey, Pennsylvania: Idea Publishing.

Griffiths, M.D. (2009). Internet gambling in the workplace. Journal of Workplace Learning, 21, 658-670.

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

Griffiths, M.D. (2010). The hidden addiction: Gambling in the workplace. Counselling at Work, 70, 20-23.

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

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., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2nd Edition), (pp.141-163). New York: Academic Press.

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

No time for the crime: Excessive adolescent video game playing, social networking and crime reduction

On Sunday February 9, 1964, The Beatles made their debut on US television. Their appearance on the Ed Sullivan Show drew an estimated audience of 73 million people. One of the most quoted consequences associated with this particular show was that between 8pm and 9pm when the show was aired, a number of news reports claimed that there was no reported incidence of juvenile crime across America during the time of the broadcast.  The editor of Newsweek, B.F. Henry, went as far as to claim that “there wasn’t so much as a hubcap stolen” during the hour that The Beatles were on the show.

This apocryphal tale, at the very least, shows the apparent compelling logic in the argument that when an activity is so engrossing it has the capacity to stop people engaging in other types of activity such as crime. Inspired by a speculative blog post on the topic, my friend and research colleague Dr. Mike Sutton failed to disconfirm what Dr. Sutton and I have called the Crime Substitution Hypothesis. We recently published a small paper in the journal Education and Health that examined the extent to which popular youth activity (namely video gaming and social networking) may be having an effect on youth offending and victimization.

Young people’s use of technology (the so called ‘screenagers’ and ‘digital natives’) has increased greatly over the last two decades and a significant proportion of daily time is spent in front of various screen interfaces most notably videogames, mobile phones (e.g., SMS) and the internet (e.g., social networking sites like Bebo, Facebook). These ‘digital natives’ have never known a world without the internet, mobile phones and interactive television, and are therefore tech-savvy, have no techno-phobia, and very trusting of these new technologies.

One of the most empirically researched areas is in the area of adolescent video gaming. Negative consequences of gaming have included addiction, increased aggression, and a variety of medical consequences, such as repetitive strain injuries, obesity, and photosensitive epilepsy. There is certainly evidence that when taken to excess, videogame playing can in some cases be addictive, especially online videogame playing where the game never pauses or ends, and has the potential to be a 24/7 activity. However, there are many reported benefits that adolescents can get from playing videogames. These can be educational, social and/or therapeutic.

Another positive benefit of playing video games along with activities like social networking may be the capacity to reduce youth crime. The reason why videogames may have implications for crime reduction is their use as ‘distractors’ (such as in the role of pain management). The reasoning is that ‘distractor tasks’ consume some degree of the attentional capacity that would otherwise be devoted to pain perception. I have noted in a number of my academic papers that the main reasons that videogames make good distractors are because they:

  • Are likely to engage much of a person’s individual active attention because of the cognitive and motor activity required.
  • Allow the possibility to achieve sustained achievement because of the level of difficulty (i.e. challenge) of most games during extended play.
  • Appear to appeal most to adolescents

For instance, one study reported the case of an eight-year-old boy with neurodermatitis being given a handheld videogame to prevent him from picking at his face. Where previous treatments had failed, the use of the game kept his hands occupied and within two weeks the affected area had healed. A number of studies have demonstrated that videogames can provide cognitive distraction for children undergoing chemotherapy. All these studies have reported that distracted child patients report less nausea after treatment (when compared with control groups), and that playing videogames reduced the amount of painkillers the children needed during treatment. The very reasons why video games may be of benefit therapeutically may also be applied to video games in a crime reduction context (i.e., the playing of video games is so cognitively distracting that that there is little time to do or think about anything else).

Consequently, there is a developing school of thought arguing that peoples’ participation (especially excessive use) in video gaming and social networking may be contributory factors that may partly explain the fall in crime rates in recent years. For instance, the economist Larry Katz was quoted in a 2010 issue of The Economist suggesting that the playing of video games may be playing a role in crime reduction. Katz’ reasoning is simple – keeping people busy keeps them out of trouble. There appears to be some statistical support for such a hypothesis as the decrease in US crime rates appears to show an inverse correlational relationship with increased sales of video game consoles and video games. Clearly this correlational evidence should be treated with caution as it says nothing about causation. However, it does provide a hypothesis that could be the subject of future empirical testing.

Could the rise in video game playing and social networking be a major cause of what criminologists claim is an unfathomable drop in crime, and if not, then why not? Routine Activity Theory predicts that if a substantial numbers of young people are not on the streets either as victims or offenders then overall high volume ‘crime opportunities’ would diminish, resulting in an overall drop in high volume crime rates. We have no idea yet whether what we might call the ‘crime substitution hypothesis’ is plausible. Therefore, in our recent paper, Dr. Sutton and I set out some ideas that support it as something possibly worthy of further exploration.

As highlighted above, research suggests some young people are spending many hours playing video games or social networking. Research also suggests that video games can be engrossing, addictive and in some cases compulsive. Additionally, research has failed to establish that violent media is either a necessary or sufficient condition for causing crime. Therefore, taking a Routine Activity Approach, it would seem that an increase in video gaming might feasibly lead to a rise in the illicit market for stolen computers and games consoles. However, there might be fewer thieves to supply it if:

  • Fewer potential offenders are getting addicted to opiates and other drugs, and/or misusing alcohol out of boredom because they have escaped boredom in the real world by entering the more exciting world of cyberspace to play and interact with others.
  • Potential offenders and victims are gaming excessively and/or compulsively checking Facebook and/or other social networking sites.
  • The game players and other ‘netizens’ are playing at home so (a) fewer potential offenders on the streets and fewer potential victims, and (b) houses are occupied for longer and so less susceptible to burglary.
  • Immersion and gaming prowess and reputation may be sufficient substitutes for the same things in the offline (real) world
  • The Internet allows more people to work from home so teleworking may reduce the pool of “available” victims on the street and also ensure fewer homes are empty during the day.

The evidence provided for the ‘crime substitution hypothesis’ in our paper was anecdotal and/or correlational in nature but we would argue that this would provide a fruitful avenue for further research. Such research into ‘crime substitution’ and gaming/social networking might involve: (i) measuring time spent gaming and social networking by groups that empirical research predicts are at greater risk of becoming offenders, (ii) conducting ethnographic studies with young people to gauge whether, and if so to what extent, gaming and social networking are used as a substitute for risky activities in the offline (real) world, and do this in relation to both potential offending and victimization, (iii) examining issues of offline and online peer status and how this may impact on consequent behaviour (including criminal activity), and (iv) further examining the correlation between console and game sales – and any data on playing time and type of games – with the general crime trend over the past 20 years.

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

Further reading

Cole, H. & Griffiths, M.D. (2007). Social interactions in Massively Multiplayer Online Role-Playing gamers. CyberPsychology and Behavior, 10, 575-583.

De Freitas, S. & Griffiths, M.D. (2008). The convergence of gaming practices with other media forms: what potential for learning? A review of the literature. Learning, Media and Technology, 33, 11-20.

Griffiths, M.D. (2005). Video games and health. British Medical Journal, 331, 122-123.

Griffiths, M.D. (2005b). The therapeutic value of videogames. In Goldstein J. & Raessens J. (eds.) Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

Griffiths, M.D. (2008). Internet and video-game addiction. In C. Essau (Ed.), Adolescent Addiction: Epidemiology, Assessment and Treatment (pp.231-267).  San Diego: Elselvier.

Griffiths, M.D. (2010). Trends in technological advance: Implications for sedentary behaviour and obesity in screenagers. Education and Health, 28, 35-38.

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

Griffiths, M.D. & Sutton, M. (2013). Proposing the Crime Substitution Hypothesis: Exploring the possible causal relationship between excessive adolescent video game playing, social networking and crime reduction. Education and Health, 31, 17-21.

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

Kuss, D.J. & Griffiths, M.D. (2011). Excessive online social networking: Can adolescents become addicted to Facebook? Education and Health, 29. 63-66.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

Sutton, M (2010) Routine Activities Theory, the Internet and the 15-Year crime drop. Criminology: The Blog of Mike Sutton. Best Thinking: http://www.bestthinking.com/thinkers/science/social_sciences/sociology/mike-sutton?tab=blog&blogpostid=9634,9634