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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.

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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.

 

Sense and sense-ability: A brief look at ‘virtual reality addiction’

Ever since I started researching into technological addictions, I have always speculated that ‘virtual reality addiction’ was something that psychologists would need to keep an eye on. In 1995, I coined the term ‘technological addictions’ in a paper of the same name in the journal Clinical Psychology Forum. In the conclusions of that paper I asserted:

“There is little doubt that activities involving person-machine interactivity are here to stay and that with the introduction of such things [as] virtual reality consoles, the number of potential technological addictions (and addicts) will increase. Although there is little empirical evidence for technological addictions as clinical entities at present, extrapolations from research into fruit machine addiction and the exploratory research into video game addiction suggest that they do (and will) exist”.

Although I wrote the paper over 20 years ago, there is little scientific evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself).

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VR’s potential in mass commercial markets appears to be finally taking off because of mass-produced affordable hardware such as Oculus Rift, HTC Vive, PlayStation VR and the (ultra-cheap) Google Cardboard (in which a smartphone can be inserted into cardboard VR headset frame). Last year, a report by the marketing and consulting company Tractica claimed that spending on virtual reality hardware could be as much as $21.8 billion (US) by 2020. A more recent report by online and digital market research company Juniper estimated that global sales of VR headsets would rise from 3 million in 2016 to 30 million by 2020. Three markets are likely drive sales, and they all happen to be areas that I research into from an addiction perspective – video gaming, gambling, and sex. I’ve noted in many of my academic papers over the years (particularly my early papers on online gambling addiction and online sex addiction) that when new technological advances occur, the sex and gambling industries always appear to be the first to invest and produce commercial products and services using such technologies, and VR is no different. As an online article in Wareable by Dan Sung on VR sex noted:

“What [VR] headsets offer is immersion; 180-degree (or more), stereoscopic action with you as the star of the show and the adult actors and actresses looking deep and lustfully into your eyes as they tend to your genitalia. It’s small wonder that users have been donning their headsets and earphones in numbers and praying to their god that nobody walks in. Yet gambling and porn are synonymous with addiction, and increasingly, questions are being asked about whether the VR revolution could finally ensnare us humans into virtual worlds”.

I was interviewed by Sung for the same article and I made a number of different observations about VR sex. I commented that in terms of people feeling reinforced, aroused, rewarded, sex is the ultimate in things that are potentially addictive. Sex is one of those activities that is highly reinforcing, it’s highly rewarding and how people feel is probably better than the highs and buzzes from other behaviours. Theoretically, I can see that VR sex addiction would be possible but I don’t think it’s going to be on the same scale as other more traditional addictions. The thing about VR (and VR sex) – and similarly to the internet – is that it’s non-face-to-face, it’s non-threatening, it’s destigmatising, and it’s non-alienating. VR sex could be like that whether it’s with fictitious partners, someone that you’re actually into, or someone that you’ve never met before. Where VR sex is concerned, if you can create a celebrity in a totally fictitious way, that will happen. There may be celebrities out there that will actually endorse this and can make money and commercialise themselves to do that. It can work both ways. Some people might find it creepy while others might see something they can make money from.

In one of my previous blogs I looked at the area of ‘teledildonics’, a VR technology that has been around for over two decades (in fact I was first interviewed on this topic on a 1993 Channel 4 television programme called Checkout ’93). Dan Sung also interviewed Kyle Machulis who runs the Metafetish teledildonics website for his article. He said that in relation to VR sex there is a problem with haptics (i.e., the science of applying tactile sensation and control to interaction with computer applications):

 “We’re good on video and audio but haptics is a really, really hard problem…A lot of toys out there right now are horrible and it’s very hard to come up with something quality. So, instead, what the porn industry is aiming for right now is immersion. It may not feel better but they’re so much closer to the action that it may be better, and I think we’re on the cusp of that right now.” First, we need consumer hardware. We need things to be released and available to customers to see if it’s really going to take off or not. But when this happens – late this year, the beginning of next – as soon as the headsets are available, the media is ready and waiting…Of course, there’s straight women, gay men and gay women to develop for too but, for a lot of people, the perfect porn experience is doing something that’s not even physically possible – either through the laws of physics or the laws of land, and that’s something that only VR can solve…Even so, what we saw in teledildonics in gaming is that people used them to begin with but there’s always a lot of fall off with new technologies like this. So, there’s going to be a hardcore set of people who stay with VR porn but it’s hard to say how popular it will be beyond that. We’re all still guessing at the moment. This time next year it will be a completely different story”.

Another area that we will need to monitor is how the gambling industry will harness VR technology. The most obvious application of VR in the gambling world is in the online gambling sector. I can imagine some online gamblers wanting their gambling experiences to be more immersive and for their online gambling sessions to be more akin to gambling offline surrounded by the sights and sounds of an offline gambling venue. There is no technical reason that I know of why people that gamble via their computers, laptops, smartphones or tablets could not wear VR headsets and be playing poker opposite a virtual opponent while still sat on the sofa at home. As Paul Swaddle (CEO of Pocket App) noted in a recent issue of Gambling Insider:

We already know that participation in online gambling is snowballing, so if the entertainment industry can use VR to simulate the experience of being inside a video game, or social media sites can give you the opportunity to not just see your friends’ pictures, but to walk through them, why shouldn’t online casinos be able to do the same? VR may actually be the hook that mobile and online casinos need to draw in more millennials, with the average age of players in mobile casinos currently being 40 [years old], and the average age of mobile gamblers in general being 35 [years old]. Millennials simply aren’t engaging with mobile and online casinos to the same extent as older generations, and I suspect that this is down to younger players being much more used to immersive and sociable gaming, as a result of the cutting-edge developments that are being constantly rolled out in the video gaming industry”.

I agree with Swaddle’s observations as the gambling industry are constantly thinking about the ways to bring in newer players. Today’s modern screenagers love technology and do not appear to have any hang-ups about using wearable technology including Fitbit and the Apple Watch. As Swaddle goes on to say:

“By using 
VR technology to transport players and their friends to exciting locations for their online gambling experience, such as a famous casino in Las Vegas, or a smoky basement room in 1920s New York, or even to the poker table in the James Bond film Casino Royale, mobile and online casinos may stand a better chance of drawing in younger audiences if they use VR to gamify the casino experience”.

Again, this makes a lot of sense to me and I wouldn’t bet against this happening. Swaddle thinks that such VR gambling experiences will become commonplace in the years to come and that the gambling industry needs to get on the VR bandwagon now. 

Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.

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

Further reading

Ashcroft, S. (2015). VR revenue to hit $21.8 billion by 2020. Wareable, July 29. Located at: http://www.wareable.com/vr/vr-revenues-could-reach-dollar-218-billion-by-2020-1451

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

Griffiths, M.D. (1996). Gambling on the internet: A brief note. Journal of Gambling Studies, 12, 471-474.

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

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

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

Griffiths, M.D., Király, O., M. Pontes, H.M. & Demetrovics, Z. (2015). An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.27-55). Oxford: Oxford University Press.

Juniper Research (2016). White paper: The rise of virtual reality. Available from: http://www.juniperresearch.com/document-library/white-papers/the-rise-of-virtual-reality

Király, O., Nagygyörgy, K., Koronczai, B., Griffiths, M.D. & Demetrovics, Z. (2015). Assessment of problematic internet use and online video gaming. An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.46-68). Oxford: Oxford University Press.

Stables, J. (2016).  Gambling, gaming and porn: Research says VR is set to blast off. Wareable, September 15. Located at: http://www.wareable.com/vr/gaming-gambling-and-porn-research-says-vr-is-set-to-blast-off-1682

Swaddle, P. (2016). Is virtual reality the future of mobile and online gambling? Gambling Insider, 23, June 3, p.9

Sung, D. (2015). VR and vice: Are we heading for mass addiction to virtual reality fantasies? Wareable, October 15. Located at: http://www.wareable.com/vr/vr-and-vice-9232

Tractica (2015). Virtual reality for consumer markets. Available at: https://www.tractica.com/research/virtual-reality-for-consumer-markets/

Meditation as self-medication: Can mindfulness be addictive?

(Please note, the following blog is an extended version of an article by my research colleagues Dr. Edo Shonin and William Van Gordon (that was first published hereand to which I have added some further text. If citing this article, we recommend: Shonin, E., Van Gordon, W. & Griffiths, M.D. (2016). Meditation as self-medication: Can mindfulness be addictive? Located at: https://drmarkgriffiths.wordpress.com/2016/10/24/meditation-as-self-medication-can-mindfulness-be-addictive/).

Mindfulness is growing in popularity and is increasingly being used by healthcare professionals for treating mental health problems. There has also been a gradual uptake of mindfulness by a range of organisations including schools, universities, large corporations, and the armed forces. However, the rate at which mindfulness has been assimilated by Western society has – in our opinion – meant that there has been a lack of research exploring the circumstances where mindfulness may actually cause a person harm. An example of a potentially harmful consequence of mindfulness that we have identified in our own research is that of a person developing an addiction to mindfulness.

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In a previous blog, the issue of whether meditation more generally can be addictive was examined. In a 2010 article by Michael Sigman in the Huffington Post entitled “Meditation and Addiction: A Two-Way Street?”, Sigman recounted the story about how one of his friends spent over two hours every day engaging in meditation while sat in the lotus position. He then claimed:

“There are those few for whom meditation can become compulsive, even addictive. The irony here is that an increasing body of research shows that meditation – in particular Buddhist Vipassana meditation – is an effective tool in treating addiction. One category of meditation addiction is related to the so-called ‘spiritual bypass’. Those who experience bliss when they meditate may practice relentlessly to recreate that experience, at the expense of authentic self-awareness. A close friend who’s done Transcendental Meditation for decades feels so addicted to it, she has a hard time functioning when she hasn’t ‘transcended’”.

Obviously, this is purely anecdotal but at least raises the issue that maybe for a very small minority, meditation might be addictive. In addition, empirical studies have shown that meditation can increase pain tolerance, and that the body produces its own morphine-like substances (i.e., endorphins). Therefore, the addictive qualities of meditation may be due to increased endorphin production that creates a semi-dissociative blissful state.

Being addicted to meditation – and more specifically mindfulness – would constitute a form of behavioural addiction (i.e., as opposed to chemical addiction). Examples of better known forms of behavioural addiction are gambling disorder, internet gaming disorder, problematic internet use, sex addiction, and workaholism. According to the components model of addiction, a person would suffer from an addiction to mindfulness if they satisfied the following six criteria:

  • Salience: Mindfulness has become the single most important activity in their life.
  • Mood modification: Mindfulness is used in order to alleviate emotional stress (i.e., escape) or to experience euphoria (i.e., a ‘high’).
  • Tolerance: Practising mindfulness for longer durations in order to derive the same mood-modifying effects.
  • Withdrawal: Experiencing emotional and physical distress (e.g., painful bodily sensations) when not practising mindfulness.
  • Conflict: The individual’s routine of mindfulness practice causes (i) interpersonal conflict with family members and friends, (ii) conflict with activities such as work, socialising, and exercising, and (iii) psychological and emotional conflict (also known as intra-psychic conflict).
  • Relapse: Reverting to earlier patterns of excessive mindfulness practice following periods of control or abstinence.

In modern society, the word ‘addiction’ has negative connotations but it should be remembered that addictions have been described by some as both positive and negative (for instance, Dr. Bill Glasser has spent his whole career talking about ‘positive’ addictions). For example, in separate clinical case studies that we conducted with individuals suffering from pathological gambling, sex addiction, and workaholism, it was observed that the participants substituted their addiction to gambling, work, or sex with mindfulness (and maybe even developed an addiction to it, depending upon the definition of addiction). In the beginning phases of psychotherapy, this process of addiction substitution represented a move forward in terms of the individual’s therapeutic recovery. However, as the therapy progressed and the individual’s dependency on gambling, work, or sex began to weaken, their “addiction” to mindfulness was restricting their personal and spiritual growth, and was starting to cause conflict in other areas of their life. Therefore, it became necessary to help them change the way they practiced and related to mindfulness.

Mindfulness is a technique or behaviour that an individual can choose to practice. However, the idea is that the individual doesn’t separate mindfulness from the rest of their lives. If an individual sees mindfulness as a practice or something that they need to do in order to find calm and escape from their problems, there is a risk that they will become addicted to it. It is for this reason that we always exercise caution before recommending that people follow a strict daily routine of mindfulness practice. In fact, in the mindfulness intervention that we (Shonin and Van Gordon) developed called Meditation Awareness Training, we don’t encourage participants to practice at set times of day or to adhere to a rigid routine. Rather, we guide participants to follow a dynamic routine of mindfulness practice that is flexible and that can be adapted according to the demands of daily living. For example, if a baby decides to wake up earlier than usual one morning, the mother can’t tell it to wait and be quite because it’s interfering with her time for practising mindfulness meditation. Rather, she has to tend to the baby and find another time to sit in meditation. Or better still, she can tend to the baby with love and awareness, and turn the encounter with her child into a form of mindfulness practice. We live in a very uncertain world and so it is valuable if we can learn to be accommodating and work mindfully with situations as they unfold around us.

One of the components in the components model of addiction is ‘salience’ (put more simply, importance). In general, if an individual prioritises a behaviour (such as gambling) or a substance (such as cannabis) above all other aspects of their life, then it’s probably fair to say that their perspective on life is misguided and that they are in need of help and support. However, as far as mindfulness is concerned, we would argue that it’s good if it becomes the most important thing in a person’s life. Human beings don’t live very long and there can be no guarantee that a person will survive the next week, let alone the next year. Therefore, it’s our view that it is a wise move to dedicate oneself to some form of authentic spiritual practice. However, there is a big difference between understanding the importance of mindfulness and correctly assimilating it into one’s life, and becoming dependent upon it.

If a person becomes dependent upon mindfulness, it means that it has remained external to their being. It means that they don’t live and breathe mindfulness, and that they see it as a method of coping with (or even avoiding) the rest of their life. Under these circumstances, it’s easy to see how a person can develop an addiction to mindfulness, and how they can become irritable with both themselves and others when they don’t receive their normal ‘fix’ of mindfulness on a given day.

Mindfulness is a relatively simple practice but it’s also very subtle. It takes a highly skilled and experienced meditation teacher to correctly and safely instruct people in how to practise mindfulness. It’s our view that because the rate of uptake of mindfulness in the West has been relatively fast, in the future there will be more and more people who experience problems – including mental health problems such as being addicted to mindfulness – as a result of practising mindfulness. Of course, it’s not mindfulness itself that will cause their problems to arise. Rather, problems will arise because people have been taught how to practice mindfulness by instructors who are not teaching from an experiential perspective and who don’t really know what they are talking about. From personal experience, we know that mindfulness works and that it is good for a person’s physical, mental, and spiritual health. However, we also know that teaching mindfulness and meditation incorrectly can give rise to harmful consequences, including developing an addiction to mindfulness.

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

Further Reading

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

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

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

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

Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

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

Shonin, E., Van Gordon W., & Griffiths, M.D. (2015). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-382.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016). Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.

Sigman, M. (2010). Meditation and addiction: A two-way street? Huffington Post, November 15. Located at: http://www.huffingtonpost.com/michael-sigman/meditation-and-addiction_b_783552.htm

Sussman, S., Lisha, N., Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professionals, 34, 3-56.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

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

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Ontological addiction: Classification, etiology, and treatment. Mindfulness, 7, 660-671.

Lust discussed: A brief overview of our recent papers on sex addiction

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, youth gambling, exercise addiction, and shopping addiction, here is a round-up of recent papers that my colleagues and I have published on sex addiction.

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.

  • At present, the prevalence of rates of sexual addiction in the UK is unknown. This study investigated what treatment services were available within British Mental Health Trusts (MHTs) that are currently provided for those who experience compulsive and/or addictive sexual behaviours within the National Health Service (NHS) system. In March and April 2013, a total of 58 letters were sent by email to all Mental Health Trusts in the UK requesting information about (i) sexual addiction services and (ii) past 5-year treatment of sexual addiction. The request for information was sent to all MHTs under the Freedom of Information Act (2001). Results showed that 53 of the 58 MHTs (91 %) did not provide any service (specialist or otherwise) for treating those with problematic sexual behaviours. Based on the responses provided, only five MHTs reported having had treated sexual addiction as a disorder that took primacy over the past 5 years. There was also some evidence to suggest that the NHS may potentially treat sexual addiction as a secondary disorder that is intrinsic and/or co-morbid to the initial referral made by the GP. In light of these findings, implications for the treatment of sex addiction in a British context are discussed.

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

  • Background and aims: Hypersexuality and sexual addiction among females is a little understudied phenomenon. Shame is thought to be intrinsic to hypersexual behaviours, especially in women. Therefore, the aim of this study was to understand both hypersexual behaviours and consequences of hypersexual behaviours and their respective contributions to shame in a British sample of females (n = 102). Methods: Data were collected online via Survey Monkey. Results: Results showed the Sexual Behaviour History (SBH) and the Hypersexual Disorder Questionnaire (HDQ) had significant positive correlation with scores on the Shame Inventory. The results indicated that hypersexual behaviours were able to predict a small percentage of the variability in shame once sexual orientation (heterosexual vs. non-heterosexual) and religious beliefs (belief vs. no belief) were controlled for. Results also showed there was no evidence that religious affiliation and/or religious beliefs had an influence on the levels of hypersexuality and consequences of sexual behaviours as predictors of shame. Conclusions: While women in the UK are rapidly shifting to a feminist way of thinking with or without technology, hypersexual disorder may often be misdiagnosed and misunderstood because of the lack of understanding and how it is conceptualised. The implications of these findings are discussed.

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.

  • Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction.

Dhuffar, M. & Griffiths, M.D. (2015). Understanding conceptualisations of female sex addiction and recovery using Interpretative Phenomenological Analysis. Psychology Research, 5, 585-603.

  • Relatively little research has been carried out into female sex addiction. There is even less regarding understandings of lived experiences of sex addiction among females. Consequently, the purpose of the present study was to examine the experiences of female sex addiction (from onset to recovery). This was done by investigating the experiences and conceptualisations of three women who self-reported as having had a historical problem with sex addiction. An interpretative phenomenological analysis (IPA) methodology was applied in the current research process in which three female participants shared their journey through the onset, progression, and recovery of sex addiction. The IPA produced five superordinate themes that accounted for the varying degrees of sexual addiction among a British sample of females: (1) “Focus on self as a sex addict”; (2) “Uncontrollable desire”; (3) “Undesirable feelings”; (4) “Derision”; and (5) “Self help, treatment and recovery”. The implications of these findings towards the understanding and the need for the implementation of treatment are discussed.

Dhuffar, M., Pontes, H.M. & Griffiths, M.D. (2015). The role of negative mood states and consequences of hypersexual behaviours in predicting hypersexuality among university students. Journal of Behavioural Addictions, 4, 181–188.

  • The issue of whether hypersexual behaviours exist among university students is controversial because many of these individuals engage in sexual exploration during their time at university. To date, little is known about the correlates of hypersexual behaviours among university students in the UK. Therefore, the aims of this exploratory study were two-fold. Firstly, to explore and establish the correlates of hypersexual behaviours, and secondly, to investigate whether hypersexuality among university students can be predicted by variables relating to negative mood states (i.e., emotional dysregulation, loneliness, shame, and life satisfaction) and consequences of hypersexual behaviour.

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, in press.

  • Sex addiction is a disorder that can have serious adverse functional consequences. Treatment effectiveness research for sex addiction is currently underdeveloped, and interventions are generally based on guidelines for treating other behavioural (as well as chemical) addictions. Consequently, there is a need to clinically evaluate tailored treatments that target the specific symptoms of sex addiction. It has been proposed that second-generation mindfulness-based interventions (SG-MBIs) may be an appropriate treatment for sex addiction because in addition to helping individuals increase perceptual distance from craving for desired objects and experiences, some SG-MBIs specifically contain meditations intended to undermine attachment to sex and/or the human body. To date, no study exploring the utility of mindfulness for treating sex addiction has been conducted. This paper presents an in-depth clinical case study of a male individual suffering from sex addiction that underwent treatment utilising an SG-MBI known as Meditation Awareness Training (MAT). Following completion of MAT, the participant demonstrated clinically significant improvements regarding the addictive sexual behaviour, as well less depression and psychological distress. The MAT intervention also led to improvements in sleep quality, job satisfaction, and non-attachment to self and experiences. Salutary outcomes were maintained at six-month follow-up. The current study extends the literature exploring the applications of mindfulness for treating behavioural addiction, and findings of this case study indicate that further clinical investigation into the role of mindfulness for treating sex addiction is warranted.

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

Further reading

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

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

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

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

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

Griffiths, M.D. & Dhuffar, M. (2014). Collecting behavioural addiction treatment data using Freedom of Information requests. SAGE Research Methods Cases. Located at: DOI: http://dx.doi.org/10.4135/978144627305014533925

“Turn and face the strange”: A personal goodbye to David Bowie

“There is a well known cliché that you should never meet your heroes but if David Bowie or Paul McCartney fancy coming round to my house for dinner I’m pretty sure I wouldn’t be lost for words”.

This was the last sentence I wrote in my blog on the psychology of being starstruck less than a month ago. I, like millions of others, was deeply shocked to learn of Bowie’s death from liver cancer earlier this week (January 10) two days after his 69th birthday.

I first remember hearing David Bowie on a 1975 edition of Top of the Pop(when the re-release of ‘Space Oddity’ reached No.1 in the British singles chart). Although I heard the occasional Bowie song over the next few years (‘Golden Years’, ‘Sound and Vision’ and ‘Boys Keep Swinging’ being some of the songs I taped off the radio during the weekly chart rundown) it wasn’t until ‘Ashes To Ashes’ reached the UK No. 1 spot in the week of my 14th birthday (late August 1980) that I became a Bowie convert.

I still vividly remember buying my first Bowie album – a vinyl copy of his first greatest hits LP (Changesonebowie) on the same day that I bought the third album by The Police (Zenyatta Mondatta) and the latest issue of Smash Hits (that had Gary Numan on the cover with a free yellow flexidisc of the track ‘My Face’ by John Foxx). It was Saturday October 4th, 1980. Ever since that day I’ve been collecting David Bowie music and now have every single song that he has ever commercially released along with hundreds of bootlegs of unreleased songs and live recordings.

My collection of Bowie books is ever growing and I have dozens of Bowie DVDs (both his music and films in which he has appeared). In short, I’m a hardcore fan – and always will be. Like many other fans, I’ve spent all this week listening to his final studio LP (Blackstar) and poring over the lyrics knowing that he wrote all these songs knowing that he had terminal cancer. The first line of ‘Lazarus’ appears particularly poignant in this regard (Look up here, I’m in heaven/I’ve got scars that can’t be seen/I’ve got drama, can’t be stolen/Everybody knows me now/Look up here, man, I’m in danger/I’ve got nothing left to lose”).

Anyone who’s been a regular reader of my blog will know that when I get a chance to mention how important he has been in my life, I do so (and do so in writing). I mentioned him in my articles on the psychology of musical preferences, on the psychology of a record-collecting completist, on record collecting as an addiction, and on the psychology of pandrogyny. I’ve also mentioned him (somewhat predictably) in my articles on the psychology of Iggy Pop, and the psychology of Lou Reed (two more of my musical heroes).

I’ve also been sneaking the titles of his songs into the titles of my blog articles ever since I started my blog including ‘Space Oddity’ (in my article on exophilia), ‘Holy Holy’ (in my article on Jerusalem Syndrome), ‘Ashes To Ashes’ (in my article on ‘cremainlining‘), ‘Under Pressure’ (in my article on inflatable rubber suit fetishism), and ‘Changes’ (in my article on transformation fetishes).

When I started writing this article I did wonder whether to do ‘the psychology of David Bowie’ but there is so much that I could potentially write about that it would take more than a 1000-word blog to do any justice to one of the most psychologically fascinating personalities of the last 50 years (Strange Fascination by David Buckley being one of the many good biographies written about him).

Trying to get at the underlying psychology of someone that changed personas (‘the chameleon of pop’) so many times during his career is a thankless task. However, his desire for fame started early and he was determined to do it any way he could whether it was by being a musician, a singer, an actor, a mime artist, an artist, or an entrepreneur (arguably he has been them all at one time or another). Being behind a mask or creating a persona (or “alternative egos” as Bowie called them) was something that got Bowie to where he wanted to be and I’m sure that with each new character he became, the personality grew out of it.

As an academic that studies addiction for a living, Bowie would be a perfect case study. Arguably it could be argued that he went from one addiction to another throughout his life, and based on what I have read in biographies a case could be made for Bowie being addicted (at one time or another) from cocaine and nicotine through to sex, work, and the Internet.

Bowie also had a personal interest in mental health and various mental disorders ran through his family (most notably his half-brother Terry Burns who was diagnosed as a schizophrenic and committed suicide in January 1985 by jumping in front of a moving train. A number of his aunts were also prone to clinical depression and schizophrenia). Bowie first tackled his “sad [mental] inheritance” in ‘All The Madmen’ (on his 1971 The Man Who Sold The World LP) and was arguably at his most candid on the 1993 hit single ‘Jump They Say’ that dealt with is brother’s mental illness and suicide.

Like John Lennon, I’ve always found Bowie’s views on almost anything of interest and he was clearly well read and articulate. He described himself as spiritual and recent stories over the last few days have claimed he almost became a Buddhist monk. Whether that’s true is debatable but he was certainly interested in Buddhism and its tenets. Now that I am carrying out research into mindfulness with two friends and colleagues who are also Buddhist monks (Edo Shonin and William Van Gordon), I have begun to read more on the topic. One of the things that Buddhism claims is that identity isn’t fixed and nowhere is that more true than in the case of David Bowie. Perhaps the chorus one of his greatest songs – ‘Changes’ from his 1971 Hunky Dory LP says it all:

Ch-ch-ch-ch-changes/Turn and face the strange/Ch-ch-changes/Don’t want to be a richer man/Ch-ch-ch-ch-changes/Turn and face the strange/Ch-ch-changes/Just gonna have to be a different man/Time may change me/But I can’t trace time”

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

Further reading

Buckley, D. (2005). Strange Fascination: David Bowie – The Definitive Story. London: Virgin Books.

Cann, K. (2010). Any Day Now: David Bowie The London Years (1947-1974). Adelita.

Goddard, S. (2015). Ziggyology. London: Ebury Press.

Hewitt, P. (2013). David Bowie Album By Album. London: Carlton Books Ltd.

Leigh, W. (2014). Bowie: The Biography. London: Gallery.

Pegg, N. (2011). The Complete David Bowie. London: Titan Books.

Seabrook, T.J. (2008). Bowie In Berlin: A New Career In A New Town. London: Jawbone.

Spitz, M. (2009). Bowie: A Biography. Crown Archetype.

Trynka, P. (2011). Starman: David Bowie – The Definitive Biography. London: Little Brown & Company.

Dosh spice: A brief look at ‘findoms’ and ‘wallet rape’

“How do y’all feel about [findom]? Weird I know. Those guys are creeps. But I use to do findom. I never dressed up or did crazy stuff like that but I used to use guys for their money. No lie (how do you think I got so many clothes) and NO I never had to send naked pics meet up with these guys or nothing, it was all simply over the internet and Paypal. They just want to splurge on you for being pretty. Well I haven’t done it in like a year and randomly one of the guys messaged me today and wanted to spend on me. I said okay why not…I was expecting like $50 tops. I haven’t talked to this guy in forever. And well let’s just say I made an extra $416 dollars today. In one minute. Literally” (Baelessboutique, vinted.com)

Earlier this week, I was contacted by Chris Summers, a journalist at the Daily Star. Summers was writing an article on exophilia (sexual arousal from aliens) and had come across my blog on the topic and was looking for some academic input into his story. He then sent me some of the tabloid tales he had published on sexual paraphilias including one published a week or so ago on ‘wallet rape’. Most definitions of ‘wallet rape’ (such as the one in the online Urban Dictionary) describe wallet rape as paying “way too much for something” resulting in “feelings of victimization, embarrassment, and guilt”. However, this was not the focus of the Daily Star article. According to Summers’ story, wallet rape refers to men who get a sexual kick out of giving money to women. More specifically:

“Hundreds of men in Britain and thousands more worldwide enjoy being under the control of a financial dominatrix or ‘findom’. These guys are not ‘sugar daddies’ who shower young lovers with expensive gifts in return for a sexual pay-off. In most cases they don’t even get to meet the ‘goddess’ they worship. They just enjoy being ‘paypigs’ or ‘slaves’…[most findoms] never [have] sex with [their] clients”.

Summers interviewed a number of individuals for his article including ‘Goddess Haven’ (a 21-year old female findom). ‘Bill’ (a 60-year old businessman who works up to 14 hours a day and is a lifelong ‘submissive’), and Dr. Jess O’Reilly (Canadian sexologist and author of The New Sex Bible). According to Goddess Haven:

“I’ve learned so much about my clientele in the three years that I’ve been on this journey. When I first started if you asked me these men were just completely weird and out of their mind, but why would I care? I was getting what I wanted out of it. As my journey progressed I realised that a lot of these people are just looking to escape their boring every day lives. A great deal of these men that serve me are ‘high powered’ businessmen who just want to come home and not be the centre of attention. Some of these men don’t even have time to spend the money they make for themselves and just want to see a beautiful woman enjoy it with no strings attached. I’ve realised that most of my clientele are turned on by losing their sense of control and being taken advantage of by a powerful woman. I’ll usually meet clients that pay well and can afford to session with me in reality. I have clients all over the world. I’ve had requests to kidnap people, tie them up and leave them in the woods. There are some findoms out there who give it a bad name, especially as it becomes more popular. There are a lot of women who are just hopping on the bandwagon and have no idea what they’re doing.”

According to the Daily Star article, Bill met Goddess Haven on the online forum Collarspace (one of a number of internet forums where findoms can meet submissives) and now “serves” her. As he said to Summers:

“I have served dozens of women in the past 40 years. I have probably spent about $200,000. [Haven] is truly one of a kind and I adore her as my goddess…She needs more than just me to complete her life. She may have lovers and she may not want me to have a lover. Whether she wants to cuckold me or put me in chastity that’s fine with me. I am just happy to serve her. I have an addiction but I really do budget. I spend about $5,000 a year on my goddess. I have a son and family obligations so they come first but I push it to the limit. I’m a normal person but I just have an addiction to serving women. [Haven is] confident and eager to explore my submissiveness”.

There was little in the article about why Bill was a submissive although Bill said he had issues with his mother who was a model, and appeared to adhere to Sigmund Freud’s theorising about the ‘Oedipus complex’ – the sexual desire shared between a son and his mother. The psychologist that Summers interviewed (Dr. Jess O’Reilly) made a number of speculations (although none of them relating to Freud’s psychodynamic theories). One of her speculations concerned the rise of the internet in relation to sexual behaviours:

“Everything predates the internet and the practice of dominating another’s finances has existed as long as currency’s history. However digital communities have created space for wider dissemination of information and virtual connections. You no longer have to leave your house to foster relationships of any kind.”

This line of thinking is similar to a number of papers I have written describing how the internet can facilitate sexual addictions among predisposed individuals (as I argued in a 2001 issue of the Journal of Sex Research) and bring together individuals with niche sexual paraphilias (as I wrote about in a 2012 issue of the Journal of Behavioral Addictions). In trying to explain why men would pay lots of money to be humiliated, Dr. O’Reilly speculated that:

“Sometimes those who are charged with a great deal of control at work, at home or in their community may see this as an exciting way to relinquish control of one area of their lives. Or it could be the thrill of humiliation and ridicule. Just as some people associate praise and adoration with sexual arousal, others have an erotic script that is dominated by emotions that are traditionally viewed as negative. Being humiliated can be a turn-on, as it forces you to be vulnerable…A sexual fetish need not entail sexual activity in the traditional sense. Sex gives us a high or a pleasure rush and so too can financial domination/submission. I would leave it up to each pay pig to determine whether or not s/he considers this fetish sexual in nature…Having a woman more powerful than you, seductive and manipulative enough to get into your mind to make you WANT to willingly hand over your money…Maybe their wives are boring and don’t offer much, maybe their wives are submissive and they just want the role switched. There’s a different reason for every client.”

Dr. O’Reilly went on to look at both the upsides and downsides of such findom/submissive relationships:

“Like any behaviour, financial domination/submission can be perfectly healthy or significantly problematic depending on how it makes the participants feel and how it impacts their lives (and their relationships). For example, if the pay pig is hiding his financial activity from his primary partner, I could see this taking a toll on their relationship. Honesty, consent and respect underlie healthy relationships – sexual and otherwise. I imagine many derive a thrill from the taboo of giving money to a stranger. However, if they derive pleasure from hiding their financial activity from a partner with whom they’ve agreed to share finances, this could be quite problematic. Most people crave a balance of security/predictability and excitement/the unknown. Blackmail plays into the latter need. In many cases, blackmail games are part of role-play and fantasy as opposed to lived reality.”

Although there is no academic research on the topic of findoms, other stories in the national press have appeared (and there’s even a short film called FinDom that has just been released – “a witty, sensitive exploration of loneliness and sexuality”). For instance, in the summer of 2015, The Journal featured a piece by Michelle Hennessey on ‘Findom in Dublin: The Irish men who are turned on by women spending their money’. As Hennessey noted:

“Readers may already be familiar with the concept of Femdom which involves a woman being dominant over a man usually through bondage, physical restraint or humiliation. Findom, as the name suggests, is all about financial domination”.

Like the article in the Daily Star, the story in The Journal also featured some similar case studies (although the men were referred to as ‘cash pigs’ and ‘money slaves’ rather than ‘pay pigs’). According to Hennessey’s journalistic research:

“The women who do this professionally are extremely active on social media and fetish websites. They post photos of themselves wearing the clothes and shoes they have been sent, pictures of them drinking cocktails that are being paid for by one of their slaves or snaps of their perfectly manicured feet. They also offer camera sessions with a variety of options, most of which involve humiliation like the domme laughing at the man. Many of their posts are extremely raunchy with some uploading photos of themselves nude or scantily clad and telling the men they could never have a woman that looks this way”.

As with any fetishistic or paraphilic behaviour, if it is carried out by two consenting adults and legal, there is nothing problematic about engaging in such activity. However, given that money is involved, this could – in a minority of cases – end up being a behaviour akin to problem gambling in that the person enjoys engaging in the behaviour but becomes problematic because the activity goes beyond the individual’s disposable income and causes problems elsewhere in their lives.

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

Further reading

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. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

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

Hennessy, M. (2015). Findom in Dublin: The Irish men who are turned on by women spending their money. The Journal, August 30. Located at: http://www.thejournal.ie/findom-dublin-2296085-Aug2015/

O’Reilly, J. (2014). The New Sex Bible: The New Guide To Sensual Love. London: Quiver.

Summers, C. (2015). ‘Wallet rape’: Meet the men who get a kick out of giving away money. Daily Star, December 27. Located at: http://www.dailystar.co.uk/news/weird-news/480000/Wallet-rape-financial-dominatrix

Naming desire: A personal look at my new job title

Back in 2002, I was incredibly proud when I became one of the youngest full Professors in the UK when I was bestowed the title of Professor of Gambling Studies based on my research contribitions to the gambling studies field. Anyone that has followed my career over the last decade (or this blog over the last four years) will no doubt have realised that my research interests and expertise include a lot more than gambling.

Although I still publish a lot of papers on gambling (12 to 17 papers per calendar year; see Appendix 1 below) I have carried out more and more research into non-gambling addictions and over the last six years (2010-2015) my refereed journal outputs on gambling have only constituted one-third of all my refereed journal outputs (32%) (see Appendix 1 and Figure 1).

Screen Shot 2015-10-31 at 13.15.27

The overwhelming majority of my published refereed papers since January 2010 (n=246; 88%) concern behavioural addictions (i.e., gambling addiction, videogame addiction, internet addiction, work addiction, sex addiction, exercise addiction, shopping addiction, dancing addiction, etc.). If gambling addiction is removed from these papers, this still leaves 56% of all my papers during the 2010-2015 period concerning other behavioural addictions (n=158). The remainder of my refereed journal papers (34 papers; 12%) mainly concern the topic of mindfulness carried out with my colleagues Edo Shonin and William Van Gordon. Even my three books in the 2010-2105 timeframe have been on three totally separate topics (i.e., problem gambling, internet addiction and mindfulness). Of my 71 book chapters in this 2010-2015 period, 22 have been on gambling addiction, 41 have been on other behavioural addictions, and 8 have concerned other topics (see Figure 2). In the ‘Further reading’ section below is some of the papers that I have published this year and even a quick glance will highlight that gambling papers are in the minority.

It is also worth noting that I am one of the most highly cited academics in the UK (soemthig else that I am very proud of) and a quick look at my Google Scholar citations profile (currently over 24,500 citations as of October 31, 2015) that of my top ten most highly cited papers, only one is on gambling adiction and the other nine concern my papers on videogame addiction and internet addiction.

Basically, my job title didn’t reflect what I was actually doing on the research front. And this is the very argument I put to my employer (Nottingham Trent University) a number of weeks ago. As far as I am aware, I am the first professor at NTU to ever ask for my title to be changed but last week I was informed by my line manager that the university was convinced by the case I put forward and from now on I will be Professor of Behavioural Addiction.

This new title change has pleased me greatly and of course subsumes the vast majority of the research that I am doing (including my research into gambling addiction). I don’t think I will ever stop carrying out research in the gambling field but my new job title will stop me feeling guilty about working in non-gambling areas. It may also stop some of few abusive emails I get regarding my blogs (saying in very colourful language that I should stop writing about other behavioural addictions and sexual paraphilias and “write about what I get paid to do”). Firstly, I would point out to these individuals that I don’t get paid to write my personal blog and even if I did, I write all my blogs in my spare time.

If you’ve read this far, then thank you. I promise normal service will be resumed in my next blog when it will be about something other than myself.

Appendix 1: Summary statistics of my refereed journal papers (January 1, 2010 to October 20, 2015)

  • 2010: Gambling papers (n=17); Behavioural addiction papers (n=19); Other papers (n=1)
  • 2011: Gambling papers (n=15); Behavioural addiction papers (n=15); Other papers (n=2)
  • 2012: Gambling papers (n=10); Behavioural addiction papers (n=28); Other papers (n=3)
  • 2013: Gambling papers (n=12); Behavioural addiction papers (n=23); Other papers (n=4)
  • 2014: Gambling papers (n=13); Behavioural addiction papers (n=33); Other papers (n=13)
  • 2015: Gambling papers (n=13); Behavioural addiction papers (n=27); Other papers (n=7)
  • In press: Gambling papers (n=8); Behavioural addiction papers (n=13); Other papers (n=4)

 

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

Further reading (some recent papers)

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

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

Auer, M. & Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M.D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

Canale, N. Santinello, M. & Griffiths, M.D. (2015). Validation of the Reasons for Gambling Questionnaire (RGQ) in a British population survey. Addictive Behaviors, 45, 276-280.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). Trait urgency and gambling problems in young people: the role of decision-making processes. Addictive Behaviors, 46, 39-44.

Canale, N., Vieno, A., Griffiths, M.D., Rubaltelli, E., Santinello, M. (2015). How do impulsivity traits influence problem gambling through gambling motives? The role of perceived gambling risk/benefits. Psychology of Addictive Behaviors, 29, 813–823.

Cleghorn, J. & Griffiths, M.D. (2015). Why do gamers buy ‘virtual assets’? An insight in to the psychology behind purchase behaviour. Digital Education Review, 27, 98-117.

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.

Dhuffar, M. & Pontes, H.M. & Griffiths, M.D. (2015). Dysphoric mood states and consequences of sexual behaviours as predictors of hypersexual behaviours in university students: An exploratory study. Journal of Behavioural Addictions, 4, 181–188.

Foster, A.C., Shorter, G.W. & Griffiths, M.D. (2015). Muscle Dysmorphia: Could it be classified as an Addiction to Body Image? Journal of Behavioral Addictions, 4, 1-5.

Greenhill, R. & Griffiths, M.D. (2015). Compassion, dominance/submission, and curled lips: A thematic analysis of dacryphilic experience. International Journal of Sexual Health, 27, 337-350.

Griffiths, M.D. (2015). Problematic technology use during adolescence: Why don’t teenagers seek treatment? Education and Health, 33, 6-9.

Griffiths, M.D., Urbán, R., Demetrovics, Z., Lichtenstein, M.B., de la Vega, R., Kun, B., Ruiz-Barquín, R., Youngman, J. & Szabo, A. (2015). A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries. Sports Medicine Open, 1:5.

Hanss, D., Mentzoni, R.A., Griffiths, M.D., & Pallesen, S. (2015). The impact of gambling advertising: Problem gamblers report stronger impacts on involvement, knowledge, and awareness than recreational gamblers. Psychology of Addictive Behaviors, 29, 483-491.

Hussain, Z., Williams, G. & Griffiths, M.D. (2015). An exploratory study of the association between online gaming addiction and enjoyment motivations for playing massively multiplayer online role-playing games. Computers in Human Behavior, 50, 221–230.

Karanika-Murray, M., Pontes, H.M., Griffiths, M.D. & Biron, C. (2015). Sickness presenteeism determines job satisfaction via affective-motivational states. Social Science and Medicine, 139, 100-106.

Király, O., Griffiths, M.D. & Demetrovics Z. (2015). Internet gaming disorder and the DSM-5: Conceptualization, debates, and controversies, Current Addiction Reports, 2, 254–262.

Király, O., Urbán, R., Griffiths, M.D., Ágoston, C., Nagygyörgy, K., Kökönyei, G. & Demetrovics, Z. (2015). Psychiatric symptoms and problematic online gaming: The mediating effect of gaming motivation. Journal of Medical Internet Research, 17(4) :e88.

Maraz, A., Eisinger, A., Hende, Urbán, R., Paksi, B., Kun, B., Kökönyei, G., Griffiths, M.D. & Demetrovics, Z. (2015). Measuring compulsive buying behaviour: Psychometric validity of three different scales and prevalence in the general population and in shopping centres. Psychiatry Research, 225, 326–334.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, 10(3): e0122866. doi:10.1371/ journal.pone.0122866

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

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.

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

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

Quinones, C. & Mark D. Griffiths (2015). Addiction to work: recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48-59.

Shonin, E., Van Gordon W., Compare, A., Zangeneh, M. & Griffiths M.D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161–1180.

Szabo, A., Griffiths, M.D., de La Vega Marcos, R., Mervo, B. & Demetrovics, Z. (2015). Methodological and conceptual limitations in exercise addiction research. Yale Journal of Biology and Medicine, 86, 303-308.

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

Rush hour: Can you be addicted to adrenaline?

(N.B. A shorter version of this article was first published in Hopes & Fears magazine).

Conceptualising addiction has been a matter of great debate for decades. For many people the concept of addiction involves the taking of drugs. However, there is now a growing movement that views a number of behaviors as potentially addictive including those that do not involve the ingestion of a drug. These include behaviors diverse as gambling, eating, sex, exercise, videogame playing, love, shopping, Internet use, social networking, and work. The term ‘adrenaline junkies’ has now passed into popular usage and usually refers to potentially dangerous activities such as bungee jumping, sky diving, BASE jumping, etc. My own view is that any activity that features continuous rewards (i.e., constant reinforcement) could be potentially addictive. I have argued in many of my papers that all addictions – irrespective of whether they are chemical or behavioral – comprise six components (i.e., salience, mood modification, tolerance, withdrawal, conflict and relapse). More specifically:

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

In short, if any ‘adrenaline junkies’ fulfilled all my six criteria I would class them as an addict. However, I have come across very few adrenaline junkies that endorse all of my six criteria. My position is that it is theoretically possible for individuals to become addicted to adrenaline producing activities but in reality, very few actually are.

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

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

Further reading

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

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

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

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

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

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

Griffiths, M.D. (2011). Workaholism: A 21st century addiction. The Psychologist: Bulletin of the British Psychological Society, 24, 740-744.

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

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

Király, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment (pp.61-95). New York: Elsevier.

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

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Meditate to medicate: Mindfulness as a treatment for behavioural addiction

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

Mindfulness is a form of meditation that derives from Buddhist practice and is one of the fastest growing areas of psychological research. We have defined mindfulness as the process of engaging a full, direct, and active awareness of experienced phenomena that is spiritual in aspect and that is maintained from one moment to the next. As part of the practice of mindfulness, a ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience.

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

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

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

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

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

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

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

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

Further reading

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

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

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

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

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2015). Mindfulness in psychology: A breath of fresh air? The Psychologist: Bulletin of the British Psychological Society, 28, 28-31.

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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