Odds on: Ten ways to help prevent problem gambling

[Please note: The following article was written with Dr. Michael Auer]

Problem gambling has become a major issue in many countries worldwide. In this short article we provide ten ways to help prevent problem gambling.

Raise the minimum age of all forms of commercial gambling to 18 years – Research has consistently shown that the younger a person starts to gamble, the more likely they are to develop gambling problems. Stopping problem gambling in adolescence is a key step in preventing problem gambling in the first place. Any venue or website that hosts gambling games should have effective age verification procedures.

Restrict the most harmful types of gambling – Most research shows that gambling activities which can be gambled on continuously such as slot machines tend to be far more problematic than discontinuous games such as weekly lotteries. More harmful forms of gambling should be restricted to dedicated gambling venues rather than housed in non-dedicated gambling premises (such as supermarkets, cafes, and restaurants).

Educate players to pre-commit when engaging in the most harmful types of gambling – Ideally, the most harmful forms of gambling should have mandatory limit-setting options for players to set their own voluntary time and money limits when playing the games. Gambling operators can also use mandatory loss limits to keep gambling expenditure to a minimum.

Take responsibility for where problem gambling lies – While all individuals are ultimately responsible for their own gambling behaviour, other stakeholders – including the gambling industry – have control over the structural and situational characteristics of gambling products. Government policymakers and legislators have a responsibility to ensure that gambling products are tightly regulated and to ensure that any given jurisdiction has the infrastructure to keep gambling problems to a minimum. Gambling operators are responsible for all advertising and marketing and need to ensure that the content is socially responsible and promotes responsible gambling. Within gambling venues, all practices and procedures should be socially responsible (such as not giving free alcohol while gambling, and no ATM machines on the gaming floor).

Put social responsibility at the heart of gambling operating practice – The most socially responsible gambling operators always puts player protection and harm minimisation at the heart of their business. They need to provide all information about their products so that individuals can make an informed choice about whether to gamble in the first place. They should advertise their products responsibly and provide their clientele with tools to aid responsible gambling, and provide help and guidance for those who think they are developing a gambling problem or have one.

Raise awareness about gambling among health practitioners and the general public – Problem gambling may be perceived as a somewhat ‘grey’ area in the field of health. However, there is an urgent need to enhance awareness about gambling-related problems within the general public and the medical and health professions.

Identify at-risk players – Big Data and Artificial Intelligence are common approaches applied in behavioural analysis across many industries. Online gambling and personalized land-based gambling operators can detect harmful behavioural patterns such as chasing losses or binge gambling. Such players can be excluded from direct marketing, specific types of games, and/or contacted to prevent the development of problem gambling.

Use personalized feedback – Research across many areas such as sports, health behaviour, as well as gambling has shown that personalized feedback can effectively change behaviour. Using behavioural data available in online gambling and personalized land-based venues, gamblers can be informed in real-time about behavioural changes in order to make them more aware and use pre-commitment tools such as limit-setting and/or self-exclusion.   

Set up both general and targeted gambling prevention initiatives – The goals of gambling intervention are to (i) prevent gambling-related problems, (ii) promote informed, balanced attitudes, and choices, and (iii) protect vulnerable groups. The guiding principles for action on gambling are therefore prevention, health promotion, harm reduction, and personal and social responsibility. This includes:

• General awareness raising (e.g. public education campaigns through advertisements on television, radio, newspapers).
• Targeted prevention (e.g. education programs and campaigns for particularly vulnerable populations such as senior citizens, adolescents, ethnic minorities).
• Awareness raising within gambling establishments (e.g. brochures and leaflets describing problem gambling, indicative warning signs, where help for problems can be sought such as problem gambling helplines, referral service, telephone counselling web-based chatrooms for problem gamblers, and outpatient treatment).
• Training materials (e.g. training videos about problem gambling shown in schools, job centres).

Educate and training those working in the gambling industry about problem gambling – All gaming personnel in any gambling establishments from shop retailers to croupiers should receive ongoing training regarding responsible gambling and problem gambling.

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

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M. & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M.D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

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.

Auer, M. & Griffiths, M.D. (2016). Personalized behavioral feedback for online gamblers: A real world empirical study. Frontiers in Psychology, 7, 1875. doi: 10.3389/fpsyg.2016.01875.

Griffiths, M.D. (2017). Evaluating responsible gambling tools using behavioural tracking data. Casino and Gaming International, 31, 41-45.

Griffiths, M.D. (2016). Gambling advertising, responsible gambling, and problem gambling: A brief overview. Casino and Gaming International, 27, 57-60.

Griffiths, M.D. & Auer, M. (2016). Should voluntary self-exclusion by gamblers be used as a proxy measure for problem gambling? Journal of Addiction Medicine and Therapy, 2(2), 00019.

Griffiths, M.D., Harris, A. & Auer, M. (2016). A brief overview of behavioural feedback in promoting responsible gambling. Casino and Gaming International, 26, 65-70.

Harris, A. & Griffiths, M.D. (2017). A critical review of the harm-minimisation tools available for electronic gambling. Journal of Gambling Studies, 33, 187–221.

Oehler, S., Banzer, R., Gruenerbl, A., Malischnig, D., Griffiths, M.D. & Haring, C. (2017). Principles for developing benchmark criteria for staff training in responsible gambling. Journal of Gambling Studies, 33, 167-186.

Wood, R.T.A. & Griffiths, M.D. (2015). Understanding positive play: An exploration of playing experiences and responsible gambling practices. Journal of Gambling Studies, 31, 1715-1734.

Wood, R.T.A., Shorter, G.W. & Griffiths, M.D. (2014). Rating the suitability of responsible gambling features for specific game types: A resource for optimizing responsible gambling strategy. International Journal of Mental Health and Addiction, 12, 94–112.

Unfruitful approaches: Why are slot machine players so hard to study?

Anyone that researches in the area of slot machine gambling will know how difficult to can be to collect data from this group of gamblers. Over a decade ago, Dr. Jonathan Parke and I published a paper in the Journal of Gambling Issues on why slot machine players are so hard to study. Almost all of the things we wrote in that paper are still highly relevant today, so this blog briefly examines some of the issues we raised. The following explanations represented our experiences of several research efforts in attempting to examine the psychology of slot machine gamblers in the UK, Canada and the United States. Our explanations are roughly divided into three categories. More specifically, these relate to what we called (i) player-specific factors, (ii) researcher-specific factors, and (iii) miscellaneous external factors.

Player-specific factors: There are a number of player-specific factors that can impede the collection of reliable and valid data. These include factors such as activity engrossment, dishonesty/social desirability, motivational distortion, fear of ignorance, guilt/embarrassment, infringement of player anonymity, unconscious motivation/lack of self-understanding, chasing, and lack of incentive. These are explained in more detail below:

• Activity engrossment – Slot machine gamblers can become fixated on their playing almost to the point where they ‘tune out’ to everything else around them. We have observed that many gamblers will often miss meals and/or utilise devices (such as catheters) so that they do not have to take toilet breaks. Given these observations, there is sometimes little chance that we as researchers can persuade them to participate in research studies – especially when they are gambling on the machine when approached.
• Dishonesty/Social desirability – It is well known that some gamblers will lie and be dishonest about their gambling behaviour. Social and problem gamblers alike are subject to social desirability factors and will be dishonest about the extent of their gambling activities to researchers (in addition to those close to them). This obviously has implications for the reliability and validity of any data collected.
• Motivational distortion – Many slot machine gamblers experience low self-esteem and when participating in research may provide ego-boosting responses that lead to motivational distortion. For this reason, many report that they win more (or lose less) than they actually do. Again, this self-report data has implications for reliability and validity of the data.
• Fear of ignorance – We have observed that many slot machine gamblers report to understand how the slot machine works when in fact they know very little. This appears to be a ‘face-saving’ mechanism so that they do not appear to be stupid and/or ignorant to the researchers.
• Guilt/embarrassment – Slot machine gamblers can often be guilty and/or embarrassed to be in the gambling environment in the first place. They like to convince themselves that they are not ‘gamblers’ but simply ‘social players’ who visit gambling environments infrequently. We have found that gamblers will often cite their infrequency of gambling as a reason or excuse not participate in an interview or fill out a questionnaire. Connected with this, some gamblers just simply do not want to face up to the fact that they gamble.
• Infringement of player anonymity – Some slot machine gamblers clearly play on machines as a means of escape. Many gamblers will perceive the gaming establishment in which they are gambling as a ‘private’ (rather than public) arena. As such, researchers who approach them may be viewed as people who are infringing on their anonymity.
• Unconscious motivation and lack of self-understanding – Unfortunately, many slot machine gamblers do not understand why they gamble themselves. Therefore, articulating this accurately to researchers can be very difficult. Furthermore, many gamblers experience the ‘pull’ of the slot machine where they feel compelled to play despite their better judgment but cannot articulate why.
• Chasing – When trying to carry out research in the playing environments (e.g., arcades, casinos, bingo halls, etc.), many regular gamblers do not want to leave ‘their’ slot machine in case someone “snipes” their machine while they are elsewhere. Understandably, gamblers are more concerned with chasing losses than participating in an interview or filling out a questionnaire for a researcher.
• Lack of incentive – Some slot machine gamblers simply refuse to take part in research because they feel that there is “nothing in it for them” (i.e., a lack of incentive). Furthermore, very few gamblers take the view that their gambling habits and experiences can be helpful to others.

Researcher-specific factors: In addition to player-specific factors, there are also some researcher-specific factors that can impede the collection of data from slot machine gamblers. Most of these factors concern research issues relating to participant and non-participant observational techniques (i.e., blending in, subjective sampling and interpretation, and lack of gambling knowledge). These are expanded on further below:

• Blending in – The most important aspect of non-participant observation work while monitoring fruit machine players is the art of being inconspicuous. If the researcher fails to ‘blend in’, slot machine gamblers soon realise they are being watched. As a result, they are increasingly likely to change their behaviour in some way. For instance, some players will get nervous and/or agitated and stop playing immediately whereas others will do the exact opposite and try to show off by exaggerating their playing ritual. Furthermore, these gamblers will discourage spectators as they are often considered to be “skimmers” (individuals trying to make profits by playing “other peoples machines”). Blending into the setting depends upon a number of factors. If the gambling establishment is crowded, it is very easy to just wander around without looking too suspicious. The researcher’s experience, age and sex can also affect the situation. In the UK, amusement arcades are generally frequented by young men and elderly women. The general rule is that the older the researcher gets, the harder it will be for them to mingle in successfully. If the arcade is not too crowded then there is little choice but to be one of the ‘punters’. The researcher will probably need to stay in the arcade for lengthy periods of time, therefore spending money is unavoidable unless the researcher has a job there – an approach that Dr. Parke took to collect data.
• Subjective sampling and interpretation – When the researcher is in the gambling environment, they cannot possibly study everyone at all times, in all places. Therefore it is a matter of personal choice as to what data are recorded, collected and observed. This obviously impacts on the reliability and validity of the findings. Furthermore, many of the data collected during observation will be qualitative in nature and therefore will not lend themselves to quantitative data analysis.
• Lack of gambling knowledge – Lack of ‘street knowledge’ about slot machine gamblers and the environments they frequent (e.g., terminology that players use, knowledge of the machine features, gambling etiquette, etc.) can lead to misguided assumptions. For instance, non-participant observation may lead to the recording of irrelevant data and/or an idiosyncratic interpretation of something that is widely known amongst gamblers. As above, this can lead to subjective interpretation issues.

External factors: In addition to player-specific and researcher-specific factors, there are also some external factors that can impede the collection of data from slot machine gamblers. Most of these factors concern the gaming industry’s reactions to researchers being in their establishments although there are other factors too. These are briefly outlined below:

• Gaming establishment design – It is clear from many of the arcades and casinos that we have done research in over the years that many are not ideally designed for doing covert research in. Non-participant observation is often very difficult in small establishments or in places where the clientele numbers are low.
• “Gatekeeper” issues and beaurocratic obstacles – The questions of ‘how?’ and ‘where?’ to access to the research situation can be gained raise ethical questions. Access is often determined by “informants” (quite often an acquaintance of the researcher) or “gatekeepers” (usually the manager of the organisation etc.). Getting permission to carry out research in a gambling establishment can be very difficult and is often the hardest obstacle that a researcher has to overcome to collect the data required. Many establishments do not have the power to make devolved decisions and have to seek the permission of their head office. The prevention of access by the industry can be for many reasons but the main ones are highlighted next.
• Management concerns – From the perspective of arcade or casino managers, the last thing they want are researchers that disturb their clientele (i.e., their players), by taking them away from their gambling and/or out of the establishment. Furthermore, they do not want us to give their customers any chance to make gamblers feel guilty about their gambling. In our experience, this is something that researchers are perceived by management to do. This obviously impacts on whether permission to carry out research is given in the first place.
• Industry perceptions – From the many years we have spent researching (and gambling on) slot machines, it has become evident that there are some people in the gaming industry that view researchers such as ourselves as ‘anti-gambling’ and/or that any research will report negatively about their clientele or establishment/organization. As with management concerns, this again impacts on whether permission to carry out research is given in the first place.

Dr. Parke and I envisaged that our explanations might enhance future research in this area by providing researchers with an understanding of some of the difficulties with data collection. Unfortunately, identification of slot machine gamblers is often limited to a “search and seek” method of trawling local gambling establishments (e.g., amusement arcades, casinos etc.). Therefore, researchers are often limited to collecting data during play rather than outside of it. Obviously data facilitation would be better if gamblers were not occupied by their machine gambling.

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

Further reading

Griffiths, M.D. (1991). The observational study of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1994). The observational analysis of marketing methods in UK amusement arcades. Society for the Study of Gambling Newsletter, 24, 17-24.

Griffiths, M.D. (1995). Adolescent Gambling. London: Routledge.

Griffiths, M.D. (1996). Observing the social world of fruit-machine playing. Sociology Review, 6(1), 17-18.

Parke, A., & Griffiths, M.D. (2004). Aggressive behavior in slot machine gamblers: A preliminary observational study. Psychological Reports, 95, 109-114.

Parke, A. & Griffiths, M.D. (2005). Aggressive behaviour in adult slot machine gamblers: A qualitative observational study. International Journal of Mental Health and Addiction, 2, 50-58.

Parke, J. & Griffiths, M.D. (2002). Slot machine gamblers – Why are they so hard to study? Journal of Gambling Issues, 6. Located at: http://jgi.camh.net/doi/full/10.4309/jgi.2002.6.7

Parke, J. & Griffiths. M.D. (2008). Participant and non-participant observation in gambling environments. ENQUIRE, 1, 1-18.

Griffiths, M.D. (2011). A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

Coining it in: Neologisms and ‘New Syndrome’ Syndrome

One of things I am very proud of in my academic career is the coining of the term ‘technological addiction’ back in 1995 (an umbrella term that I invented to describe a number of different person-machine addictions including slot machine addictions, video game addiction, television addiction, etc.). I’m also proud of coining the term ‘aca-media’ (relating to academics like myself that use the media to disseminate our research). A neologism (i.e., the name for a newly coined term) is often (according to Wikipedia) directly attributable to a specific event, person, publication, or period.

In the 1980s and early 1990s, there seemed to be a real upsurge is the naming of ‘new syndromes’ in the medical literature including many relating to excessive use of technology (such as ‘Space Invader’s Wrist’) and other leisure activities (such as ‘Cuber’s Thumb’ relating to excessive use of the Rubik’s Cube) – both of which made their appearance in 1981 issues of the New England Journal of Medicine. Other videogame medical complaints include ‘Pseudovideoma’ (in a 1984 issue of the Journal of Hand Surgery), ‘Pac-Man Phalanx’ (in a 1983 issue of Arthritis and Rheumatism) and ‘Joystick Digit’ (in a 1987 issue of the Journal of the American Medical Association). Another videogame-related medical complaint (in this case an infection), was reported in a 1987 issue of the Western Journal of Medicine by Dr. G.B. Soe and colleagues:

“We wish to focus WJM readers’ attention on another complication associated with video games-one that originally presented as an “infected spider bite. A 17-year-old right-handed boy noted progressive swelling and redness of his left hand seven days before admission. Two days before admission he was given penicillin intramuscularly and oral cephalexin to take at home. The swelling did not subside and the hand became very painful, so he came to the medical center for treatment. On admission his mother reported that she had seen many spiders around the house with a violin pattern on their backs, and that her son had probably been bitten by a spider…After seven days of parenteral antibiotic therapy, the edema, erythema and fever had disappeared and the patient was discharged home. Further questioning revealed that the young man was spending almost all of his time playing his favorite video game, which involved a fighting kung fu character. The patient used his left hand in manipulating a ball-shaped joystick to move the figure up, down, left and right, and his right in operating buttons to kick and jab. Extensive use of the joystick resulted in blisters on his left palm. He rubbed the blisters off, and an infection resulted that progressed to abscess formation. Neuromuscular complications of video games (‘pseudovideoma’, ‘Pac-Man phalanx’, ‘firing-finger syndrome’ and ‘Space Invaders wrist’) have been reported, as well as video game-induced seizures, but we have not come across any reports of an infectious complication of video games. Perhaps video game players should wear gloves to protect their palms, similar to ones worn by golfers and baseball players, who also need to get a firm grip on their respective sticks”.

Another one that I’d never heard of is ‘Nurd Knuckles’ coined by Dr. J.B. Martin in the Canadian Medical Association Journal in 1982:

“I wish to describe a case of painful knuckles associated with the use and manipulation of a new, allegedly therapeutic product, a Nurd. A Nurd is a head 10 cm across with a smiling face and large ears, reminiscent of the character Yoda of ‘Star Wars’. It is made of malleable material that can be stretched, twisted or deformed in any direction, yet with release of tension quickly resumes its original shape without a trace of distortion. A 32-year-old public school teacher presented with painful knuckles of his right hand. His students, perhaps feeling that their teacher was under increased stress during the marking of exams, had given him a Nurd for Christmas, and during a particularly trying day he had found occasion to use it. He repeatedly stretched its ears and twisted its neck without ill effect; however, on punching it he suffered sharp pain of his fourth and fifth metacarpophalangeal joints. On examination the joints were found to be reddened, with point tenderness over the fifth metacarpal head; there was no evidence of deformity. He was advised to stop beating his Nurd, and the pain subsided. While the Nurd is very plastic, yielding to the linear tension of stretching and twisting, it is very resistant to compression. Punching a Nurd does not cause the surface to give way, and, since the force of the blow is returned to the fist, it is conceivable that a fracture might result. Therefore, although stretching and twisting Nurds does not cause any harm, users should be cautioned against punching their Nurd. The Nurd is advertised as being a ‘punchable, stretchable, pushable and likeable alternative to tension, migraine headaches, drug abuse, alcoholism and manic depression’, but these claims are unsubstantiated. A MEDLINE search of the medical literature shows that no retrospective or prospective case control studies or controlled double blind crossover studies have been undertaken. Before the clinical efficacy of the Nurd can be taken seriously in the treatment of this broad spectrum of disease, full clinical trials must be completed. Subjects entering into trials must, however, be duly informed of the hazards of punching Nurds”.

Another one that caught my attention was a new affliction (‘Breaker’s Neck’) caused by the craze of ‘break dancing’ reported by Dr. Bertha Ramirez and her colleagues in a 1984 issue of the Journal of the American Medical Association. (The reason why I say it caught my eye is that I am currently involved in some research on ‘dancing addiction’ with some of my Hungarian colleagues and we have just had a new paper accepted in the journal PLoS ONE concerning the development of our ‘Dancing Motives Inventory’ – see ‘Further Reading’ below).

“To be added to the rapidly growing list of socially acquired injuries, we report a case of traumatic cervical subluxation caused by a new dance technique. This technique, labeled ‘breaking’ by its devotees, involves a modified head stand, in which the dancer, using his arms and hands for balance, spins rapidly on his head, neck, or shoulders to the rhythm of disco music. He then lowers his body to the floor and performs a series of rotational motions using his arms as a fulcrum…A 15-year-old boy was seen in our pediatric emergency room complaining that, on awakening two days previously, he felt a ‘snap’ in his neck, followed by persistent neck stiffness. He reported having ‘danced on his head’ the night prior to this incident. On physical examination, his head was tilted to the left with an inability to flex”.

Engaging in excessive sporting activity has given rise to a number of medical syndromes. One such consequence is ‘Rower’s Rump’ reported by Drs. K Tomecki and J. Mikesell in a 1987 issue of the Journal of the American Academy of Dermatology. In a previous blog I examined addiction to cycling. In the 1980s there were many medical complaints reported as a result of excessive cycling. One such complaint (given the name of ‘Bicycling nipples’) was highlighted by Dr. B. Powell in a 1983 issue of the Journal of the American Medical Association:

“Bicyclists are likely to suffer from a number of maladies, including dysuria, numb penises, and more. During cool or cold weather, another problem, bicyclist’s nipples, may occur. This condition is similar to jogger’s nipples, but it is primarily a thermal injury instead of an irritation secondary to friction, as with the jogger’s complaint. Often the rider is out in the cold weather for some time, and his or her undershirt, jersey, and jacket can become moist from perspiration. Evaporation and the chill of the wind lower the temperature of the nipples. They get downright cold, and they hurt. The pain continues after the ride is over. Indeed, it can continue for several days. The nipples are sore, sensitive to both temperature change and touch”.

After reading this I found out that Dr. Fred Levit had reported a case of ‘Jogger’s Nipples’ in a 1977 issue of the New England Journal of Medicine. All of these related nipple conditions are all examples of fissure of the nipple as they are all caused by friction resulting in soreness, dryness or irritation to, or bleeding of, one or both nipples. The Wikipedia entry also notes that “the condition is also experienced by women who breastfeed, and by surfers who do not wear rash guards”. The article also noted that:

“Jogger’s nipple is caused by friction from the repeated rubbing of a t-shirt or other upper body clothing against the nipples during a prolonged period of exercise. The condition is suffered mainly by runners. Long-distance runners are especially prone, because they are exposed to the friction on the nipple for the greatest period of time. However, it is not only suffered by athletes; the inside of a badge, a logo on normal items of clothing, or breastfeeding can also cause the friction which results in this condition”.

Outside of the leisure sphere, there were two case study reports of ‘Diaper Doer’s Hand’ in a 1987 issue of the journal Clinical Rehabilitation by Dr. J.L. Cosgrove and colleagues:

“Three cases of stenosing tenosynovitis occurred three to six months postpartum. Childcare activities aggravated the symptoms of pain and swelling in both patients. In two cases, a specific method of carrying the child was implicated as the mechanism of injury. Although there was no evidence of generalized inflammatory arthritis, all patients had very low positive titres of anti-nuclear antibodies. While it is likely that tenosynovitis was caused by mechanical factors, the possibility of increased susceptibility to inflammatory disease in the postpartum period cannot be discounted. The patients were successfully treated with a low temperature plastic splint, superficial heat and gentle mobilization”.

All of these new syndromes lead to why I put this article together in the first place. I found this letter in the British Medical Journal by Dr. E.P. Hoare entitled ‘New Syndrome Syndrome’ that I found both funny and poignant:

“Your readers will be familiar with tennis elbow, brazier’s ague, and soap packer’s jig not to mention Achilles’ heel. More recently we have heard of Space Invader’s wrist, jogger’s nipples, and the ultimate futility of Cuber’s thumb. May I point out another occupational disease which I have noticed among patrons of the reading room medical journal correspondence column reader’s neck or, more succinctly, the new syndrome syndrome. Symptoms usually begin with muscular contraction of the eyebrows, hyperventilation, and involuntary utterances, which in severe cases can lead to coprolalia. These may be followed by drowsiness, disorientation, hysterical amblyopia, and double vision (of the deja vu variety). If untreated the condition can result in a chronic pain in the neck. Treatment is 200 ml of gin and tonic stat by mouth and complete rest; music can also be helpful. The long-term prognosis is poor, however, unless journal editors can be persuaded to ban further reports of occupational afflictions or at least print a health warning at the head of their correspondence columns”.

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

Further reading

Behr, J.T. (1984). Pseudovideoma. Journal of Hand Surgery, 9(4), 613.

Cosgrove, J. L., Welch, D. A., Richardson, G. S., & Nicholas, J. J. (1987). Diaper doer’s hand: stenosing tenosynovitis in the postpartum period. Clinical Rehabilitation, 1(3), 219-223.

Gibofsky, A. (1983). Pac‐Man phalanx. Arthritis and Rheumatism, 26(1), 120.

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

Griffiths, M.D. (1995). Pop psychology and “aca-media”: A reply to Mitchell. The Psychologist: Bulletin of the British Psychological Society, 8, 537-538.

Griffiths, M.D. (2001). A moral obligation in aca-media? The Psychologist: Bulletin of the British Psychological Society, 14, 460.

Hite, P. R., Greene, K. A., Levy, D. I., & Jackimczyk, K. (1993). Injuries resulting from bungee-cord jumping. Annals of emergency medicine, 22(6), 1060-1063.

Hoare, E.P. (1982). Points: New syndrome syndrome. British Medical Journal, 285(6352), 1429.

Levit, F. (1977). Jogger’s nipples. New England Journal of Medicine, 297(20), 1127.

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, in press.

Martyn, J. B. (1983). Nurd knuckles. Canadian Medical Association Journal, 129(3), 228.

McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.

Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.

Powell, B. (1983). Bicyclist’s nipples. Journal of the American Medical Association, 249(18), 2457-2457.

Ramirez, B., Masella, P. A., Fiscina, B., Lala, V. R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.

Tomecki, K. J., & Mikesell, J. F. (1987). Rower’s rump. Journal of the American Academy of Dermatology, 16(4), 890-891.

Torre, P. R., Williams, G. G., Blackwell, T., & Davis, C. P. (1993). Bungee jumper’s foot drop peroneal nerve palsy caused by bungee cord jumping. Annals of emergency medicine, 22(11), 1766-1767.

Waugh, D. (1981). Cuber’s thumb. New England Journal of Medicine, 305, 768.

Tech’s appeal: Is there a relationship between addiction to video games and slot machines?

Back in 1987, I began my PhD on slot machine addiction, and one thing that I began to notice as I spent the first few hours of (100s of hours) doing observational research in amusement arcades that there were many similarities between arcade slot machines and arcade video game machines. It wasn’t until 1991 that I finally did a comparative analysis of slot machine gambling and video game playing and published my observations in the Journal of Adolescence. In the intervening years I have published many papers examining the commonalities and similarities between these two behaviours and it wouldn’t surprise me if I am still writing about these issue in many years to come.

My initial insights into the existence of video game addiction arose out of the research I had been doing on slot machine addiction. Both slot machines and video game machines may be considered under the generic label of “amusement machines”. The main difference between the playing of video games and the playing of slot machines are that arcade video games are typically played to accumulate as many points as possible whereas slot machines are played (i.e., gambled upon) to accumulate money. In my 1991 paper, I (somewhat paradoxically) claimed that playing an arcade video game could be considered as a non-financial form of gambling.

Both types of machine require insertion of a coin to play, although the playing time on a slot machine is usually much less than on a video game machine if starting with the same amount of money. This is because on video games the outcome is almost solely due to skill, whereas on slot machines the outcome is much more likely to be a product of chance. However, the general playing philosophy of both slot machine players and video game players is to stay on the machine for as long as possible using the least amount of money. I have also argued that regular slot machine players play with money rather than for it, and that winning money is a means to an end (i.e., to stay on the machine as long as possible). This is exactly what arcade video game players do too.

Besides the generic labeling, their geographical juxtaposition, and the philosophy for playing, it could be argued that on both a psychological and behavioural level, slot machine gambling and video game playing share many similarities (e.g., similar demographic differences such as age and gender breakdown, similar reinforcement schedules, similar potential for “near miss” opportunities, similar structural characteristics involving the use of light and sound effects, similarities in skill perception, similarities in the effects of excessive play, etc.). The most probable reason the two forms have rarely been seen as conceptually similar is because video game playing does not involve the winning of money (or something of financial value) and therefore cannot be classed as a form of gambling.

However, the next generation of slot machines is starting to use video game graphics and technology. While many of these relate to traditional gambling games (e.g., roulette, poker, blackjack, etc.) there are plans for developing video gambling games in which people would win money based on their game scores. This obviously gives an idea of the direction that slot machines and the gaming industry are heading.

Furthermore, there are a growing number of researchers who suggest that video games share some common ground with slot machines including the potential for dependency. On 1995, Dr Sue Fisher and myself edited a special issue of the Journal of Gambling Studies and wrote a paper examining trends in slot machine gambling. We pointed out that arcade video games and slot machines shared some important structural characteristics, these being:

• The requirement of response to stimuli that are predictable and governed by the software loop.
• The requirement of total concentration and hand–eye coordination.
• Rapid span of play negotiable to some extent by the skill of the player (more marked in video games).
• The provision of aural and visual rewards for a winning move (e.g., flashing lights, electronic jingles).
• The provision of an incremental reward for a winning move (points or money) that reinforces “correct” behaviour.
• Digitally displayed scores of “correct behaviour” (in the form of points or money accumulated).
• The opportunity for peer group attention and approval through com- petition.

As with excessive slot machine playing, excessive video game playing partly comes about by the partial reinforcement effect. This is a critical psychological ingredient of video game addiction whereby the reinforcement is intermittent – that is, people keep responding in the absence of reinforcement hoping that another reward is just around the corner. Knowledge about the partial reinforcement effect gives the video game designer an edge in designing appealing games. Magnitude of reinforcement is also important. Large rewards lead to fast responding and greater resistance to extinction – in short to more “addiction.” Instant reinforcement is also satisfying.

Video games rely on multiple reinforcements (i.e., what I call the “kitchen sink” approach) in that different features might be differently rewarding to different people. Success on video games comes from a variety of sources and the reinforcement might be intrinsic (e.g., improving a personal high score, beating a friend’s high score, putting a name on the “hall of fame,” mastering the machine) or extrinsic (e.g., peer admiration). As early as the 1980s, Dr. Thomas Malone reported that video game engagement is positively correlated to (i) a presence or absence of goals, (ii) the availability of automatic computer scores, (iii) the presence of audio effects, (iv) the random quality of the games, and (v) the degree to which rapid reaction times enhance game scores.

In 2007, Dr Jonathan Parke (Salford University, UK) and I developed a new taxonomy of structural characteristics related to gambling, listing all the known structural characteristics that have been shown to influence gambling behaviour in some way. All the 60+ structural characteristics were grouped into one of six types of characteristic:

• Speed and frequency characteristics: Factors relating to the frequency, duration and expediency of the game or reward.
• Playability characteristics: Factors that make gambling fun, interaction and/or engaging.
• Payment characteristics: Factors that relate to how one pays to gamble
• Reward characteristics: Factors relating to how one receives financial rewards or winnings.
• Educational characteristics: Factors that educate, protect, or provide information to players.
• Ambient characteristics: Factors that may influence the immediate situation of the game or may contribute to other factors already mentioned (e.g., the use of colour and sound).

Using this typology, Dr Parke and I argued that future research and policy initiatives may be to focus on regulating structural factors relating to payment (spending) and player awareness/education and focus less on structural factors relating to playability (which may also include reward, ambient, and speed characteristics). In this way, slot machines can continue to be fun, exciting, and play inducing, but with the eventual aim of minimizing harm.

It wasn’t until 2010 that I – along with Dr Daniel King and Dr Paul Delfabbro (both at the University of Adelaide, Australia) – developed a separate taxonomy of structural characteristics related to video game playing (published in the International Journal of Mental health and Addiction). We used some earlier empirical work that I had done with Dr Richard Wood (GamRes Ltd, Canada) back in 2004 and published in the journal CyberPsychology and Behavior. We devised a list of structural features by (a) playing a variety of video games, (b) examining and comparing known gambling structural characteristics, (c) discussing these features with players of video games, and (d) examining relevant research in the area of video game design. Our framework included the following characteristics:

• Sound, including sound effects, speaking characters and background music.
• Graphics, including high-quality realistic or cartoon-style graphics and full motion video (FMV).
• Background and setting, including whether the game is based on a story, film, or television program, and the use of realistic or fantasy settings.
• Duration of game, referring to how long the game usually takes to complete.
• Rate of play, referring to how quickly the player “absorbs” or “gets into” the game. & Advancement rate, referring to how quickly the game play advances.
• Use of humour in the game.
• Control options, referring to what the player can control in the game (including sound, graphics, and skill settings, choice of control methods, and physical feedback). &
• Game dynamics, including exploring new areas, elements of surprise, fulfilling a quest, skill development, AI interactions, collecting things, avoiding things, surviving against the odds, shooting, different ending options, different modes of transport, solving puzzles, beating times, cheats/Easter eggs, solving time limited problems, building environments, mapping, and linear/non-linear game format.
• Winning and losing features, referring to the potential to gain or lose points, finding bonuses, having to start level again, and ability to save regularly.
• Character development, referring to character development over time and character customization options.
• Brand assurance, referring to brand loyalty and/or celebrity endorsement.
• Multiplayer features, referring to various multi-player options, communication methods, building alliances, and beating other players.

Using this paper, and the gambling structural characteristics taxonomy, we developed our new video game structural characteristics taxonomy comprising five types of feature. These were: (a)

• Social features (i.e., social aspects of video game playing)
• Manipulation and control features (i.e., the role of user input in influencing in-game outcomes)
• Narrative and identity features (e.g., the role of character creation and interactive storytelling)
• Reward and punishment features (i.e., the ways in which players win and lose in video games)
• Presentation features (e.g., the visual and auditory presentation of video games).

Since developing the taxonomy, we have started to test it out empirically. Dr. King, Dr. Delfabbro and myself recently published a study investigating our structural characteristic taxonomy among 421 video game players (aged between 14 and 57 years). Our results showed that the reward and punishment features, such as earning points, finding rare game items, and fast loading times, were rated among the most enjoyable and important aspects of video game playing. There was some evidence that certain structural characteristics were stronger predictors of problematic involvement in video games than factors such as gender, age, and time spent playing. This included the use of adult content in the game, earning points, getting 100% in the game, and mastering the game. Our latest research supports the notion that some structural characteristics in video games may play a significant role in influencing problem video game playing behaviour.

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

Further reading

Fisher, S.E., & Griffiths, M.D. (1995). Current trends in slot machine gambling: Research and policy issues. Journal of Gambling Studies, 11, 239-247.

Griffiths, M.D. (1991). The observational analysis of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1991). Amusement machine playing in childhood and adolescence: A comparative analysis of video games and fruit machines. Journal of Adolescence, 14, 53-73.

Griffiths, M.D. (1995). Adolescent gambling. London: Routledge.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2005). The relationship between gambling and videogame playing: A response to Johansson and Gotestam. Psychological Reports, 96, 644-646.

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling.  In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

Griffiths, M.D. (2011).  A typology of UK slot machine gamblers: A longitudinal observational and interview study. International Journal of Mental Health and Addiction, 9, 606-626.

King, D.L., Delfabbro, P.H., Derevensky, J. & Griffiths, M.D. (2012). The classification of video games with gambling themes and content: An Australian perspective. International Gambling Studies, in press.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2011). The role of structural characteristics in problematic video game play: An empirical study. International Journal of Mental Health and Addiction, 9, 320-333.

Malone, T.W. (1981). Toward a theory of intrinsically motivating instruction. Cognitive Science, 4, 333–369.