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

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

mark-haifa-keynote-2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hello, good buy: Another look at shopping addiction

With only a few shopping days left until Christmas, I thought I would take another (hopefully topical) look at shopping addiction. Earlier this year, the Journal of Psychoactive Drugs published a paper by Dr. Heidi Hartston on the case for shopping as an addiction. She argued that the main factors that contribute to shopping addictions are (i) a hyper-stimulating experience (or an experience that was hyper-stimulating during initial exposures); (ii) easy accessibility or a high likelihood of frequent engagement; and (iii) vulnerability to addiction, which can be genetically present or can be created by neuroadaptation or reward deficiency syndrome.

In the section of her paper on the creation of hyper-stimulating experiences, Hartston claimed that in 1903 when Coca-Cola removed the cocaine out of their product, their marketing research found increasingly sophisticated ways to act on the brain’s reward circuitry by utilizing (i) advertising, (ii) product experience and (iii) packaging. According to Harston:

“Neuromarketing is the use of scientific brain research to potentiate the effectiveness of product marketing. This research uses fMRI brain imaging, EEG, skin moisture levels, heart rate, breathing patterns, eye movement and pupil dilation among other scientific measures. Marketing firms have spent 6.8 billion dollars in research (leading to 117 billion in advertising) learning to maximize the influence that branding, packaging, product placement and ad content can have on shopper decisions to buy. Many neuromarketing studies bypass the conscious adult rational decision-making brain functions to maximize excitement, emotional attachment, brand attachment, reward pathway activation, medial prefrontal identification and oxytocin stimulation, influencing impulsive buying decisions in ways individuals are not aware of or informed about (Robischon 2010)”

She then went on to claim that huge multi-national companies like Disney, Google, Frito-Layand and CBS (as well as large election campaigns) use these neuromarketing techniques to examine reactions by consumers (and voters) to their brands (or candidates) and then alter their advertising strategies accordingly. To support these claims, Hartston notes:

“A few examples of scientifically informed marketing include incorporating the color red (think of the coke can) resulting in attributions of intelligence and power to owning a product or to sales people (Elliot & Aarts 2011). ‘Sneaker radio’, a muzak-like soundtrack designed for use in athletic shoe stores, is designed to slow a shopper’s pace through the store and increase impulsive purchases. Studies using fMRI scans can identify which ad strategies trigger the consumer to strongly desire a product, saying they are ‘itching to buy’ (Thompson 2003). Bypassing interaction with the cortex and maximizing stimulation of emotional and reward areas can create hyperstimulating and difficult to resist marketing and can sabotage a vulnerable shopper’s intentions and efforts to resist buying”.

Hartston also makes further interesting observations in how commercial companies can hyper-stimulate shopping by exaggerating the sense of importance to the buying of products, or to the process of shopping itself. Shopping is a behaviour that has the capacity to become a highly rewarding experience. Such rewards can include excitement, identity affirmation, accomplishment, and praise. For a minority, shopaholism may become a difficult behaviour to break. Such observations not only have implications for shopping purchases but also behaviours that I study in my own research such as gambling. In relation to shopping addiction and increased accessibility, Hartston noted that:

“Behaviors may not reach the intense level of [dopamine] hyperstimulation that drugs do when each separate exposure is compared. However, because addictive behaviors are more easily accessible and more frequently engaged in than drug use (more exposures per day or week), the net effect of many more frequent exposures can make an addictive behavior hyperstimulating enough to have similar behavioral and physiological consequences as drugs”.

Comparing two different drug addictions – nicotine addiction and heroin addiction – she notes that nicotine clearly has a much weaker reward stimulation (per exposure) but can be equally addictive as heroin. The key difference is obviously the frequency as smokers will continually smoke cigarettes throughout the day whereas the number of times a heroin addict will take heroin during the day will be considerably less. In essence, Hartston argued:

“More exposures means more pairings of use and mild hyperstimulation, more encoding of the positive associations with smoking in memory, more consistent hyperstimulation of DA reward areas and more ease in increasing use. Due to its ease of availability, someone who tries smoking is more likely to become addicted than someone who tries heroin (Hilts 2009)”.

Relating this to shopping, Hartston makes the point that shopping is no longer something that is time limited by closed shops. The internet has brought the potential for 24/7 shopping. As with other activities with the potential for addiction (e.g., gambling, video gaming, sex), the internet has brought easy access, high availability, convenience, anonymity, dishinibition, and escape. As Hartston rightly asserts:

“A shopper can browse or purposefully seek target items during many stolen moments each day, from almost any location, or for extended amounts of time whenever a break may occur. Impulses to buy can be acted on immediately, without the protective time delay there used to be. And the steps to completing a purchase have become shortened, with credit card numbers already saved and one-click purchasing options additionally catering to impulsivity”.

Finally, Hartston argues that brain changes associated with Reward Deficiency Syndrome make it harder to stop the behaviors like excessive shopping. There is growing evidence that both chemical and behavioural addictions not only trigger changes in dopamine reward physiology “but also to its cortical connections, thereby impairing self-regulation”. Any person is responsible for their own behaviour but Harston argues that changes to the brain’s physiology makes it harder for vulnerable and susceptible people to control such behaviours. As Harston points out:

“Actions ‘preferred’ (valued at higher importance) by hyperstimulated striatal neurons are more likely to occur despite the addict’s conscious insight (Lau & Glimcher 2008; Hikosaka et al. 2008; Hikosaka, Nakamura & Nakahara 2006). This means that when desires become addictions they can have an overriding command over behavior and decision making, which is difficult to interrupt even in the presence of insight or higher goals. Addicted brains also show less age-related expansion of white matter, reflecting a loss of learning capacity and difficulty making new choices, further inhibiting an addict’s control over impulsive reward seeking behaviors (Goldstein & Volkow 2002). People who find themselves in the trap of addiction, whether to a drug or a behavior like shopping, need to be able to access effective interventions and support in order to stop the problematic behavior and prevent relapses”

Shopping appears to be the latest normal everyday behaviour (along with behaviours like exercise, eating and sex) to have been pathologized. However, (as I noted in my previous blog on shopaholism), there does seem to be some empirical evidence that a small minority of people appear to display addictive-like symptoms as a result of their shopping behaviour. Dr. Harston has done a good job in pointing out of the biological and situational reasons for how and why such addictions may develop.

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

Further reading

Elliot, A. & Aarts, H. (2011). Perception of the color red enhances the force and velocity of motor output. Emotion, 11, 445–49.

Goldstein, R. & Volkow, N. (2002). Drug addiction and its underlying neurobiological basis: Neuroimaging evidence for the involvement of the frontal cortex. American Journal of Psychiatry, 159, 1642–52.

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

Hartston, H. (2012). The case for compulsive shopping as an addiction. Journal of Psychoactive Drugs, 44, 64–67.

Hikosaka, O., Nakamura, K., & Nakahara, H. (2006). Basal ganglia orient eyes to reward. Journal of Neurophysiology, 95, 567–84.

Hikosaka, O., Bromberg-Martin, E., Hong, S. & Matsumoto, M. (2008). New insights on the subcortical representation of reward. Current Opinion in Neurobiology, April 18, 203–08.

Hilts, P. (1994). Is nicotine addictive? It depends on whose criteria you use. New York Times. August 2.

Lau, B. & Glimcher, P. (2008). Value representations in the primate striatum during matching behavior. Neuron, 58, 451–63.

Robischon, N. (2010.) Neuromarketing the 2010 elections: Scoring campaign ads. Fast Company. Nov 5. Available at http://www.fastcompany.com/1700207/campaign-ads-and-neuromarketing

Thompson, C. 2003. There’s a sucker born in every medial prefrontal cortex. New York Times Magazine. October 26, 54–65.

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