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Trait expectations: Another look at why addictive personality is a complete myth

In the 30 years that I have been carrying out research into addiction, the one question that I have been asked the most – particularly by those who work in the print and broadcast media – is whether there is such a thing as an ‘addictive personality’? In a previous blog I briefly reviewed the concept of ‘addictive personality’ but since publishing that article, I have published a short paper in the Global Journal of Addiction and Rehabilitation Medicine on addictive personality, and in this blog I review I outline some of the arguments as to why I think addictive personality is a complete myth.

Psychologists such as Dr. Thomas Sadava have gone as far to say that ‘addictive personality’ is theoretically necessary, logically defensible, and empirically supportable. Sadava argued that if ‘addictive personality’ did not exist then every individual would vulnerable to addiction if they lived in comparable environments, and that those who were addicted would differ only from others in the specifics of their addiction (e.g., alcohol, nicotine, cocaine, heroin). However, Sadava neglected genetic/biological predispositions and the structural characteristics of the substance or behaviour itself.

There are many possible reasons why people believe in the concept of ‘addictive personality’ including the facts that: (i) vulnerability is not perfectly correlated to one’s environment, (ii) some addicts are addicted to more than one substance/activity (cross addiction) and engage themselves in more than one addictive behaviour, and (iii) on giving up addiction some addicts become addicted to another (what I and others have referred to as ‘reciprocity’). In all the papers I have ever read concerning ‘addictive personality’, I have never read a good operational definition of what ‘addictive personality’ actually is (beyond the implicit assumption that it refers to a personality trait that helps explain why individuals become addicted to substances and/or behaviours). Dr. Craig Nakken in his book The Addictive Personality: Understanding the Addictive Process and Compulsive Behaviour argued that ‘addictive personality’ is “created from the illness of addiction”, and that ‘addictive personality’ is a consequence of addiction and not a predisposing factor. In essence, Nakken simply argued that ‘addictive personality’ refers to the personality of an individual once they are addicted, and as such, this has little utility in understanding how and why individuals become addicted.

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When teaching my own students about the concept of ‘addictive personality’ I always tell them that operational definitions of constructs in the addictive behaviours field are critical. Given that I have never seen an explicit definition of ‘addictive personality’ I provide my own definition and argue that ‘addictive personality’ (if it exists) is a cognitive and behavioural style which is both specific and personal that renders an individual vulnerable to acquiring and maintaining one or more addictive behaviours at any one time. I also agree with addiction experts that the relationship between addictive characteristics and personality variables depend on the theoretical considerations of personality. According to Dr. Peter Nathan there must be ‘standards of proof’ to show valid associations between personality and addictive behaviour. He reported that for the personality trait or factor to genuinely exist it must: (i) either precede the initial signs of the disorder or must be a direct and lasting feature of the disorder, (ii) be specific to the disorder rather than antecedent, coincident or consequent to other disorders/behaviours that often accompany addictive behaviour, (iii) be discriminative, and (iv) be related to the addictive behaviour on the basis of independently confirmed empirical, rather than clinical, evidence. As far as I am aware, there is no study that has ever met these four standards of proof, and consequently I would argue on the basis of these that there is no ‘addictive personality’.

Although I do not believe in the concept of ‘addictive personality’ this does not mean that personality factors are not important in the acquisition, development, and maintenance of addictive behaviours. They clearly are. For instance, a paper in the Psychological Bulletin by Dr. Roman Kotov and his colleagues examined the associations between substance use disorders (SUDs) and higher order personality traits (i.e., the ‘big five’ of openness to experience, conscientiousness, agreeableness, extraversion, and neuroticism) in 66 meta-analyses. Their review included 175 studies (with sample sizes ranged from 1,076 to 75,229) and findings demonstrated that SUD addicts were high on neuroticism (and was the strongest personality trait associated with SUD addiction) and low on conscientiousness. Many of the studies the reviewed also reported that agreeableness and openness were largely unrelated to SUDs.

Dr. John Malouff and colleagues carried published a meta-analysis in the Journal of Drug Education examining the relationship between the five-factor model of personality and alcohol. The meta-analysis included 20 studies (n=7,886) and showed alcohol involvement was associated with low conscientiousness, low agreeableness, and high neuroticism. Mixed-sex samples tended to have lower effect sizes than single-sex samples, suggesting that mixing sexes in data analysis may obscure the effects of personality. Dr. James Hittner and Dr. Rhonda Swickert published a meta-analysis in the journal Addictive Behaviors examining the association between sensation seeking and alcohol use. An analysis of 61 studies revealed a small to moderate size heterogeneous effect between alcohol use and total scores on the sensation seeking scale. Further analysis of the sensation seeking components indicated that disinhibition was most strongly correlated with alcohol use.

Dr. Marcus Munafo and colleagues published a meta-analysis in the journal Nicotine and Tobacco Research examining strength and direction of the association between smoking status and personality. They included 25 cross-sectional studies that reported personality data for adult smokers and non-smokers and reported a significant difference between smokers and non-smokers on both extraversion and neuroticism traits. In relation to gambling disorder, Dr. Vance MacLaren and colleagues published a meta-analysis of 44 studies that had examined the personality traits of pathological gamblers (N=2,134) and non-pathological gambling control groups (N=5,321) in the journal Clinical Psychology Review. Gambling addiction was shown to be associated with urgency, premeditation, perseverance, and sensation seeking aspects of impulsivity. They concluded that individual personality characteristics may be important in the aetiology of pathological gambling and that the findings were similar to the meta-analysis of substance use disorders by Kotov and colleagues.

More recently, I co-authored a study with Dr. Cecilie Andreassen and her colleagues in the Journal of Behavioral Addictions. We carried out the first ever study investigating the inter-relationships between the ‘big five’ personality traits and behavioural addictions. They assessed seven behavioural addictions (i.e., Facebook addiction, video game addiction, Internet addiction, exercise addiction, mobile phone addiction, compulsive buying, and study addiction). Of 21 inter-correlations between the seven behavioural addictions, all were positive (and nine significantly so). More specifically: (i) neuroticism was positively associated with Internet addiction, exercise addiction, compulsive buying, and study addiction, (ii) extroversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying, (iii) openness was negatively associated with Facebook addiction and mobile phone addiction, (iv) agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying, and (v) conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying and positively associated with exercise addiction and study addiction. However, replication and extension of these findings is needed before any definitive conclusions can be made.

Overall these studies examining personality and addiction consistently demonstrate that addictive behaviours are correlated with high levels of neuroticism and low levels of conscientiousness. However, there is no evidence of a single trait (or set of traits) that is predictive of addiction, and addiction alone. Others have also reached the same conclusion based on the available evidence. For instance, R.G. Pols (in Australian Drug/Alcohol Review) noted that findings from prospective studies are inconsistent with retrospective and cross-sectional studies leading to the conclusion that the ‘addictive personality’ is a myth. Dr. John Kerr in the journal Human Psychopharmacology: Clinical and Experimental noted that ‘addictive personality’ had long been argued as a viable construct (particularly in the USA) but that there is simply no evidence for the existence of a personality type that is prone to addiction. In another review of drug addictions, Kevin Conway and colleagues asserted (in the journal Drug and Alcohol Dependence) there was scant evidence that personality traits were associated with psychoactive substance choice. Most recently, Maia Szalavitz in her book Unbroken Brain: A Revolutionary New Way of Understanding Addiction noted that:

“Fundamentally, the idea of a general addictive personality is a myth. Research finds no universal character traits that are common to all addicted people. Only half have more than one addiction (not including cigarettes)—and many can control their engagement with some addictive substances or activities, but not others”.

Clearly there are common findings across a number of differing addictions (such as similarities in personality profiles using the ‘big five’ traits) but it is hard to establish whether these traits are antecedent to the addiction or caused by it. Within most addictions there appear to be more than one sub-type of addict suggesting different pathways of how and way individuals might develop various addictions. If this is the case – and I believe that it is – where does that leave the ‘addictive personality’ construct?

‘Addictive personality’ is arguably a ‘one type fits all’ approach and there is now much evidence that the causes of addiction are biopsychosocial from an individual perspective, and that situational determinants (e.g., accessibility to the drug/behaviour, advertising and marketing, etc.) and structural determinants (e.g., toxicity of a specific drug, game speed in gambling, etc.) can also be influential in the aetiology of problematic and addictive behaviours. Another problem with ‘addictive personality’ being an explanation for why individuals develop addictions is that the concept inherently absolves an individual’s responsibility of developing an addiction and puts the onus on others in treating the addiction. Ultimately, all addicts have to take some responsibility in the development of their problematic behaviour and they have to take some ownership for overcoming their addiction. Personally, I believe it is better to concentrate research into risk and protective factors of addiction rather than further research of ‘addictive personality’.

As I have argued in a number of my papers and book chapters, not every addict has a personality disorder, and not every person with a personality disorder has an addiction. While some personality disorders appear to have an association with addiction including Antisocial Personality Disorder and Borderline Personality Disorder, just because a person has some of the personality traits associated with addiction does not mean they are, or will become, an addict. Practitioners consider specific personality traits to be warning signs, but that’s all they are. There is no personality trait that guarantees an individual will develop an addiction and there is little evidence for an ‘addictive personality’ that is predictive of addiction alone. In short, ‘addictive personality’ is a complete myth.

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

Further reading

Andreassen, C.S., Griffiths, M.D., Gjertsen, S.R., Krossbakken, E., Kvan, S., & Ståle Pallesen, S. (2013). The relationships between behavioral addictions and the five-factor model of personality. Journal of Behavioral Addictions, 2, 90-99.

Conway, K. P., Kane, R. J., Ball, S. A., Poling, J. C., & Rounsaville, B. J. (2003). Personality, substance of choice, and polysubstance involvement among substance dependent patients. Drug and Alcohol Dependence, 71(1), 65-75.

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

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. (2009). The psychology of addictive behaviour. In: M. Cardwell, M., L. Clark, C. Meldrum & A. Waddely (Eds.), Psychology for A2 Level (pp. 236-471). London: Harper Collins.

Griffiths, M.D. (2017). The myth of ‘addictive personality’. Global Journal of Addiction and Rehabilitation Medicine, 3(2), 555610.

Hittner, J. B., & Swickert, R. (2006). Sensation seeking and alcohol use: A meta-analytic review. Addictive Behaviors, 31(8), 1383-1401.

Kerr, J. S. (1996). Two myths of addiction: The addictive personality and the issue of free choice. Human Psychopharmacology: Clinical and Experimental, 11(S1), S9-S13.

Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin, 136(5), 768-821.

MacLaren, V. V., Fugelsang, J. A., Harrigan, K. A., & Dixon, M. J. (2011). The personality of pathological gamblers: A meta-analysis. Clinical Psychology Review, 31(6), 1057-1067.

Malouff, J. M., Thorsteinsson, E. B., Rooke, S. E., & Schutte, N. S. (2007). Alcohol involvement and the Five-Factor Model of personality: A meta-analysis. Journal of Drug Education, 37(3), 277-294.

Munafo, M. R., Zetteler, J. I., & Clark, T. G. (2007). Personality and smoking status: A meta-analysis. Nicotine & Tobacco Research, 9(3), 405-413.

Nakken, C. (1996). The addictive personality: Understanding the addictive process and compulsive behaviour. Hazelden, Center City, MN: Hazelden.

Nathan, P. E. (1988). The addictive personality is the behavior of the addict. Journal of Consulting and Clinical Psychology, 56(2), 183-188.

Pols, R. G. (1984). The addictive personality: A myth. Australian Alcohol/Drug Review, 3(1), 45-47.

Sadava, S.W. (1978). Etiology, personality and alcoholism. Canadian Psychological Review/Psychologie Canadienne, 19(3), 198-214.

Szalavitz M (2016). Unbroken brain: A revolutionary new way of understanding addiction. St. Martin’s Press, New York.

Szalavitz M (2016). Addictive personality isn’t what you think it is. Scientific American, April 5.

If phonely: Are you addicted to your mobile phone?

A couple of weeks ago I was interviewed by Debating Europe (DE) about smartphone addiction. I was asked four questions and my responses were transcribed, edited, and published on the DE website on July 11. Only the responses to two of the questions were published, so my blog today provides the full transcript of my interview. I have emboldened each of the four questions and my response follows each question.

Vicki worries about the impact of smartphones on children. She thinks that parents nowadays are too prone to buying the latest phones for their kids, without taking into consideration possible alternatives. What are the risks of children being addicted to their phones?

Well, first thing to say is that children and adults are no more addicted to their smartphones than alcoholics are addicted to a bottle. What we’re really talking about here is the application that people have on smartphones. Obviously, children now seem to getting smartphones at a younger and younger age. I’m often asked what is an appropriate age to give children smartphones. There is no right answer on this, but I certainly don’t advocate giving smartphones to children under the age of 11 years.

I think when children move to their secondary schools, most children in the class will have a smartphone, and to not give your child a smartphone can ostracise them from the class. The issue about smartphones in terms of excessive use is that sometimes parents do actually pathologise their children’s excessive smartphone use, particularly if they don’t use a smartphone much themselves. For me, the issue is whether their smartphone use interferes with the other important things in their lives?

There are typically four things I ask parents: One, is smartphone use affecting your child’s education and homework? Two, is their smartphone use affecting their physical education? Three. is their smartphone use affecting the chores you expect your children to do around the house? And, finally, does the smartphone use affect their face-to-face interaction with their friends? Typically, most parents, if they’ve answered honestly, will answer that the smartphone doesn’t affect any of those four domains. But if a parent does feel it’s affecting those four domains, then it is the parent’s responsibility to do something about it.

As a parent myself, I know that taking a smartphone off a child can be very difficult sometimes and can lead to negative reactions by the child. But at the end of the day, a parent is there to parent. They’re there to oversee their child’s development into – hopefully – a thriving adult who’s got all the capacities to go on in the world. Using smartphones, unfortunately or fortunately – depending upon your viewpoint – is now a natural thing and, particularly in teenage years, that is what children do. So I think it comes down to everything in moderation and parents absolutely have the right to restrict screen time and in extreme circumstances actually take the smartphones away.

smartphone-addiction

Stella thinks we’re being too negative about mobile phones. She thinks technology such as smartphones actually increases the sense of community and allows for expression of opinions. What would you say to her? Is she right to be so optimistic or should it be tempered?

It’s all about moderation. I personally think the advantages of smartphones far outweigh the disadvantages. I’m actually an unusual person. I actually gave using up my mobile phone a number of years ago, and I’ve now learned to live without one. But – to be honest – particularly for most teenagers, this is absolutely essential in their day-to-day social armoury. I don’t think there’s any argument that there should be a ban or a prohibition on smartphones because, as I said, the advantages far outweigh the disadvantages.

The scientific research says that a very small minority seem to overuse their smartphones, particularly young people aged between 14-to-25 years. We’ve got teenagers, older adolescents and emerging adults who heavily use their smartphones. I think most of that use is what I call ‘habitual use’. It’s not ‘problematic use’, it’s just something that people get into a habit of doing, always looking at their mobile phones even when there hasn’t been a ‘ping’ or a beep to say there’s been a notification or a message. People still automatically look at their smartphone even if there’s no sound. It’s almost like a classically conditioned response.

I think more people pathologise use. For most people, their smartphone use is not pathological in any way, shape, or form. It’s just that, sometimes, excessive use is pathologised by people who don’t like mobile phones. I notice mobile phones when I’m in a restaurant or a pub, because I don’t have one myself. I’m actually very conscious when somebody else is looking at their mobile phone during mid-conversation, and that has led to this phrase ‘phubbing’, which is ‘phone snubbing’ and which goes on all the time. But that, in and of itself, is not an addiction and is not excessive.

I certainly think that in terms of the question asked, I do think there’s a lot of good things to say about mobile phones and I wouldn’t want to be in a position where they’re not around because for some people they’re life-savers and for some it’s part of their social armoury. I do think that the way social media operators use their psychological hooks to get people to look at their phones is something where the onus is on the social media operators rather than the individuals.    

Reader ‘Randomguy2017’ is sceptical of the benefits of technological progress. He argues that depression and anxiety are higher than ever, as our addiction to smartphones grow. Is there a link between the two?

As far as I’m aware – and I may be wrong – there is no scientific longitudinal study that has looked at the relationship between smartphone use, depression and anxiety. I certainly think it’s a case where it’s a bit of a ‘chicken and egg’ thing. If you’re somebody that’s prone to anxiety or depression, you’re more likely to use smartphones or the Internet as a way masking depression and anxiety. There’s also some research that suggests excessive use of smartphones and the Internet can lead to social anxiety and depression. So, like I said before, there’s a bit of ‘chicken and the egg’ here. It may be also be that there is a bit of both.

Again, I would really stress that the number of people that would be genuinely addicted to applications on their smartphone are very few and far between. I think what we’ve got more now is that the excessive smartphone use sometimes leads to problematic behaviour. It could be that you’re looking at your smartphone while you’re driving, or you prefer to look at your smartphone rather than talk to somebody in front of you face-to-face. Those kind of things, they are what I would say are ‘problematic’ and annoying and, in the case of driving, could actually be fatal, but none of those are necessarily addictive or pathological.

However, I do think we have to put these things into perspective. The vast majority of people that use smartphone-based technologies, it’s something that’s life-affirming, life-enhancing, that adds to their life. But that doesn’t take away the fact that small minority out there that their use of smartphones takes away from other important things in their life. And in a tiny minority of cases the application that people are engaging in online whether its social networking, gaming, or gambling might be potentially addictive. But I take a holistic approach in this, in that the advantages far outweigh the disadvantages.

Emil is concerned about the privacy implications of our reliance on phones. Is he correct in assuming hackers can easily access what we do on our phones?

This is not my research area as I don’t look at privacy issues in relation to Internet and smartphone use. However, I’ve got access to people’s data from gambling companies and we do research on that data. I think that people have got to realise that anything they do online, when you’ve signed up to do anything, whether it’s a gambling service, a gaming service, a social networking site, is that you are – in effect – giving your data away.

When my kids come to me and say to me, ‘Can I do this, it’s free?’ I have to educate my children when anything is free, via smartphone or the Internet, then you yourself are the product that’s actually being sold. It’s very hard to educate a 12 or 13-year-old about that, but I think you can say to adults that their data is being used and sold in ways that they never imagined.

But I do think that this ‘big data’ revolution that we’ve got now can result in very good potential uses of that data, particularly at an aggregate level. But I certainly know that on an individual level, I don’t like my own data being used. If I sign up and buy things from Amazon, I know they’re going to use my data. If I sign up to use Facebook, I know my data is being used some way. So it’s a bit of give and take. In Europe, we’ve just had new regulation regarding data privacy. Obviously governments are trying to get on top of this, but we now live in a digital world, we leave digital footprints, and our data is going to be used in ways we never thought it might be used in the first place. That is the trade-off between having all these advantages of new technologies versus those privacy issues.

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

Further reading

Balakrishnan, J. & Griffiths, M.D. (2018). ‘Addictive’ smartphone games and their features: A largescale qualitative study using online reviews by videogame players. International Journal of Mental Health and Addictions, in press.

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.

Csibi, S., Griffiths, M.D., Cook, B., Demetrovics, Z., & Szabo, A. (2018). The psychometric properties of the Smartphone: Applications-Based Addiction Scale (SABAS). International Journal of Mental Health and Addiction, 16, 393-403.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Hussain, Z., Griffiths, M.D. & Sheffield, D. (2017). An investigation in to problematic smartphone use: The role of narcissism, anxiety, and personality factors. Journal of Behavioral Addictions, 6, 378–386.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

Lopez-Fernandez, O., Kuss, D.J., Pontes, H.M., Griffiths, M.D., Dawes, C., … Billieux, J. (2018). Measurement invariance of the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across eight languages. International Journal of Environmental Research and Public Health, 15, 1213. doi:10.3390/ijerph15061213

Lopez-Fernandez, O., Männikkö, N., Kääriäinen, M., Griffiths, M.D., & Kuss, D.J. (2018). Mobile gaming does not predict smartphone dependence: A cross-cultural study between Belgium and Finland. Journal of Behavioral Addictions, 7, 88-99.

Richardson, M., Hussain, Z. & Griffiths, M.D. (2018). Problematic smartphone use, nature connectedness, and anxiety. Journal of Behavioral Addictions, 7, 109-116.

Every little ring: Another look at excessive smartphone use

Last week I did seven back-to-back BBC radio interviews concerning my thoughts on a new study on smartphone use carried out by Opinium Research for Virgin Mobile and reported in a number of papers including the Daily Mail. The company surveyed 2,004 British adults (aged 18 years and over) who own a smartphone as well 200 British teenagers and tweenagers aged between 10 and 17 years. The main findings were that:

  • British adults receive an average of 33,800 mobile phone messages and alerts annually
  • British adults spend the equivalent of 22 days a year checking messages on their smartphones (an average of 26 minutes a day)
  • An average smartphone user gets 93 buzzes a day
  • Those aged between 18 and 24 years have almost three times more messages receiving 239 messages and alerts a day on average (approximately 87,300 a year).
  • On average, Britons are members of six chat groups, although a small minority (2%) are members of 50 groups or more, rising to 7% among those aged 18 to 24 years.
  • One in four adults say they check a WhatsApp message instantly, with this increasing to almost one in three among 18 to 24-year-olds.
  • Smartphone users receive 427% more messages and notifications than they did a decade ago
  • Smartphone users sent 278% more messages than they did a decade ago

The survey found a contributing factor behind the surge in the number of messages received was the rise of group chats on platforms like WhatsApp and Facebook. In the press release, Dr Dimitrios Tsivrikos (consumer and business psychologist at University College London) said:

“The boom in smartphone use was a positive trend and allowed consumers greater control over their lives. In an age where we are constantly surrounded by endless tasks, always flooded with a sea of data, smartphones allow us to manage our lives in a way that suits us. From calendars and reminders, to emails and instantaneous access to an encyclopaedia of human knowledge, smartphones give us total control, right at our fingertips.”

FRANCE-ECONOMY-TELECOMMUNICATION-SMARTPHONES

There was nothing in the study that I found particularly surprising but I was hoping to see what survey had found from those under 18 years of age (but nothing was reported in the national newspapers and I’ve been unable to track down anything beyond the press release).

In my radio interviews, most of the presenters wanted to know the extent to which individuals are now ‘addicted’ to their mobile phones. I then trotted out my usual response that ‘people are no more addicted to their smartphones than alcoholics are addicted to a bottle’ and said if there was anything addicting then it was the application (e.g., gaming, gambling, shopping, social networking, etc.) rather than the smartphone itself. I also went through the addiction components model and hypothesized what the behaviour of a smartphone addict would look like if they were genuinely addicted to their smartphone applications:

  • Salience – This occurs when using a smartphone becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually on their smartphone they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with smartphone use).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of using their smartphone 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’ whenever they use their smartphone).
  • Tolerance – This is the process whereby increasing amounts of time on a smartphone are required to achieve the former mood modifying effects. This basically means that for someone engaged on a smartphone, they gradually build up the amount of the time they spend using a smartphone 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 access their smartphone because they have mislaid or lost it, are too ill to use it, in a place with no reception, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much time on a smartphone.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive smartphone use to recur and for even the most extreme patterns typical of the height of excessive smartphone use to be quickly restored after periods of control.

Using these criteria, I then went on to say that very few people would be classed as addicted to their smartphones. However, I did point out that such behaviour is on a continuum and that there may be a growing number of people that experience problematic smartphone use rather than being addicted. The examples I used included those individuals who would rather spend time on their smartphone than spending it with their partner and/or children, or individuals who spend so much time on their smartphone that it impacts on their job or their education (depending upon how old they are). Neither of these on their own (or together) necessarily indicate addictive use of smartphones but could be a sign that such individuals are at risk for developing an addiction to the applications on their smartphone. However, I would still argue that someone that spends all their time on social networking sites and social media (via their mobile phone) are a social media addict rather than a smartphone addict although others might see this as a semantic difference rather than a difference of substance. Whatever we call the behaviour, there does seem to be growing evidence that smartphones play a major role in people’s lives and that a small minority appear to have problematic use (as outlined in a number of studies that I have co-authored – see ‘Further reading’ below).

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

Further reading

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.

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Oberst, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Csibi, S., Griffiths, M.D., Cook, B., Demetrovics, Z., & Szabo, A. (2018). The psychometric properties of the Smartphone: Applications-Based Addiction Scale (SABAS). International Journal of Mental Health and Addiction. doi: 10.1007/s11469-017-9787-2

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Hussain, Z., Griffiths, M.D. & Sheffield, D. (2017). An investigation in to problematic smartphone use: The role of narcissism, anxiety, and personality factors. Journal of Behavioral Addictions, 6, 378–386.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

Lopez-Fernandez, O., Kuss, D.J., Romo, L. Morvan, Y., Kern, L., … Griffiths, M.D., … Billieux, J. (2017). Self-reported dependence on mobile phones in young adults: A European cross-cultural empirical survey. Journal of Behavioral Addictions, 6, 168-177.

Lopez-Fernandez, O., Männikkö, N., Kääriäinen, M., Griffiths, M.D., & Kuss, D.J. (2018). Mobile gaming does not predict smartphone dependence: A cross-cultural study between Belgium and Finland. Journal of Behavioral Addictions. doi: 10.1556/2006.6.2017.080

Richardson, M., Hussain, Z. & Griffiths, M.D. (2018). Problematic smartphone use, nature connectedness, and anxiety. Journal of Behavioral Addictions. doi: 10.1556/2006.7.2018.10

 

Distraction plans: Excessive smartphone use and pain perception

In a previous blog I outlined many physical syndromes that had been reported in the 1980s medical literature, a number of which related to excessive video game playing. This included ‘Space Invader’s Wrist’ (published in the New England Journal of Medicine), ‘Pseudovideoma’ (Journal of Hand Surgery), ‘Pac-Man Phalanx’ (Arthritis and Rheumatism) and ‘Joystick Digit’ (Journal of the American Medical Association). More recently, other new medical complaints have been reported related to excessive mobile phone use including a report of ‘Blackberry thumb’ in a 2013 issue of the Canadian Medical Association Journal. 

Earlier this month saw the publication of a case report involving a tendon rupture in a man excessively playing a video game on his smartphone. The report appeared in JAMA Internal Medicine by Dr. Andrew Doan and his colleagues (the same Dr. Doan that reported a case study of someone “addicted” to Google Glass that I examined in a previous blog). The authors of the latest report wrote:

“We describe a patient with rupture of the extensor pollicis longus tendon associated with excessive video game play on his smartphone. A 29-year-old, right hand–dominant man presented with chronic left thumb pain and loss of active motion. Before the onset of symptoms, he reported playing a video game on his smartphone all day for 6 to 8 weeks. He played with his left hand while using his right hand for other tasks, stating that ‘playing was a kind of secondary thing, but it was constantly on.’ When playing the video game, the patient reported that he felt no pain. He reported no injuries or prior operations to either hand. He denied a history of inflammatory arthritis, quinolone use, or other predisposing medical condition for ten-don rupture. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The findings on physical examination of the patient’s right hand were unremarkable. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. A magnetic resonance imaging study of his left hand revealed tendon attenuation and rupture of the tendon. Radiographic studies of the wrist found no bone spurs or prior or current fractures. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints”

One of the things that I found interesting was that despite the tendon rupture, when the man was actually playing the game, he felt no pain. This is something I know only too well from personal experience. Unfortunately, I have a chronic and degenerative spinal complaint (herniated discs in my neck) but I feel no pain whatsoever when I am cognitively distracted. I find that work is a much better analgesic than dihydrocodeine (i.e., when I am working I feel no pain whatsoever). However, playing video games come a close second as when I am engaged in video game playing (even on simple casual games), the fact that it takes up all my cognitive resources means that I don’t feel any pain. This is nothing new and many medics are aware of the therapeutic benefits of gaming. There are now many studies showing that children undergoing chemotherapy need much less pain relief if they play video games after their treatment compared to children that don’t play video games. (In fact I’ve written a number of papers and book chapters on ‘video game therapy’ – see ‘Further reading’ below). This case report then went on to say:

“Video games suppress pain perception in pediatric patients and during burn treatments. Visual distraction and neuroendocrine hypothalamic-pituitary-adrenal arousal provide a plausible explanation for why the patient did not feel pain from his injury. Without the expected physiologic negative pain feedback, excessive gaming may have led to tendon attenuation and subsequent attritional rupture of the tendon. Attritional rupture at the midtendon differs from high- energy ruptures that occur where the tendon is thinnest or be- tween tendon and bone. Although this is only a single case report, research might consider whether video games have a role in clinical pain management and as nonpharmacologic alternatives during uncomfortable or painful medical procedures. They may also have a role in reducing stress. It may be interesting to ascertain whether various games differ in their ability to reduce the perception of pain…Research might also consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming”.

This conclusion does appear to suggest that the authors are unaware of the many hundreds of studies that have examined the therapeutic benefits of gaming (in fact there’s even an academic journal dedicated to such studies appropriately called the Games For Health Journal). As I have noted in a number of my writings about video gaming as a medical intervention for children:

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

Consequently, videogames have also been used in a number of studies as ‘distractor tasks’. This latest case report highlights the simultaneous potential positive and negatives of gaming within a single individual but also highlights the fact that video gaming is both mobile and spreading to many more types of hardware. I’m now wondering which medical team will be the first to write about a new medical syndrome relating to the new Apple Watch.

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.

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

Gilman, L., Cage, D.N., Horn, A. Bishop, F., Klam, W.P. & Doan, A.P. (2015). Tendon rupture associated with excessive smartphone gaming. JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.0753

Griffiths, M.D. (2003). The therapeutic use of videogames in childhood and adolescence. Clinical Child Psychology and Psychiatry, 8, 547-554.

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

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

Griffiths, M. D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

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.

O’Sullivan, B. (2013). Beyond BlackBerry thumb. CMAJ, 185, 185-186.

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.

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

Downwardly mobile? A brief look at cell phone addiction

“One in ten people say they are addicted to their smartphone, a poll has revealed. And more owners than ever are seeking expert help. The US study of 2,000 college students found ten per cent claimed to have a full-blown addiction to the gadgets. Eighty-five per cent constantly checked theirs for the time, while three-quarters slept beside it. Meanwhile counsellor Peter Smith reported a ten per cent increase in Brits seeking help for smartphone addiction at his clinic in Weston-Super-Mare, Somerset. He said: ‘Smartphone users feel they’ve got more control to communicate with whoever they want, whenever they want. But ironically, it’s that sense of control that creates the anxiety. It’s made younger people more reliant on maintaining those contacts – which can create issues from bullying, to being marginalised and excluded. People lose track of time, becoming socially isolated and before they know it, can’t stop. Not having your phone raises your heart rate and signs of panic. These symptoms are almost identical to alcoholism or addiction to gambling, food or drugs” (The Sun, March 21, 2013)

The news report above appeared in The Sun newspaper last week, and as part of that article I was asked to devise a 10-item ‘smartphone addiction test’ for Sun readers which I did (and can be found at the end of today’s blog). As regular readers of my blog will be aware, I have been studying ‘technological addictions’ for over two decades and I coined the term ‘technological addictions’ in a paper I wrote back in 1995. Although I have published a lot of papers on various technological addictions (e.g., slot machine addiction, video game addiction, internet addiction, etc.), I have only ever published one study on mobile phone addiction (with some of my research colleagues in Ramon Llull University, Barcelona, Spain).

Our study was published last year in the Anales de Psicologia, and comprised 1,879 students from Catalonian educational institutions (322 students of Ramon Llull University, and 1,557 secondary school students). We surveyed the students using the 10-item ‘Questionnaire on Cell Phone Related Experiences’ (Cuestionario de Experiencias Relacionadas con el Movil [CERM]), a psychometric instrument developed by Dr. Marta Beranuy and her colleagues in 2009. The CERM examines two areas of cell phone use conflicts and communicative/emotional use.

Our study reported that frequent problems with cell phone use were reported by 2.8 % of the participants. Problematic use was greatest in the youngest age groups. Perhaps unsurprisingly, the most used applications were text-messaging and making calls. We carried out a regression analysis and found that the types of cell phone use that contributed the most to problematic use were text-messaging and playing games, whereas making calls contributed the least. Our results suggest that very few young people have problems with cell phones, in contrast with the findings of previous studies in Spain that reported pathological cell phone rates of 7.9%-10.4%. Our results suggested that females have some difficulties with phone use. Other researchers have also reported that females use cell phones more than males, and perceive their use as more problematic than. We also noted in our paper that cell phones are becoming more varied in their use and new applications such as the playing of games appears to be more attractive to males.

Traditionally, the use of cell phones has been for communication and as such, the risk of problematic use was minimal. However, this risk of problematic use and/or addiction could be potentially higher for smartphones that include applications that promote the altering of user identity (e.g., gaming, social networking, etc.).

We also argued that some people may confuse habitual use of such technology as an addictive behaviour (when in reality it may not be). For instance, some people may consider themselves cell phone addicts because they never go out of the house without their cell phone, do not turn their cell phone off at night, are always expecting calls from family members or friends, and/or over-utilise cell phones in their work and/or social life. There is also the importance of economic and/or life costs. The crucial difference between some forms of cell phone use and pathological cell phone use is that some applications involve a financial cost. If a person is using the application more and is spending more money, there may be negative consequences as a result of not being able to afford the activity (e.g., negative economic, job-related, and/or family consequences). High expenditure may also be indicative of cell phone addiction but the phone bills of adolescents are often paid for by parents, therefore the financial problems may not impact on the users themselves.

It is very difficult to determine at what point cell phone use becomes an addiction. The cautiousness of researchers suggests that we are not yet in a position to confirm the existence of a serious and persistent psychopathological addictive disorder related to cell phone addiction on the basis of population survey data alone. This cautiousness is aided and supported by other factors including: (a) the absence of any clinical demand in accordance with the percentages of problematic users identified by these investigations, (b) the fact that the psychometric instruments used could be measuring ‘concern’ or ‘preoccupation’ rather than ‘addiction, (c) the normalisation of behaviour and/or absence of any concern as users grow older; and (d) the importance of distinguishing between excessive use and addictive use.

All researchers agree in the necessity of longitudinal studies in order to check if perception of the problematic use of cell phones still exists over time. Many university students on the basis of self-report claim to have been ‘addicted’ to texting/instant messaging during some period of their adolescence. Our research suggests they are simply describing a period of their development with strong needs of social ties rather than a true addiction. If any of you reading this really want to know if you may have a problem with your smartphone, then you can take this test I devised. If you answer ‘yes’ to six or more of these statements, it may be indicative of a problematic and/or addictive use of your smartphone.

(1)  “My smartphone is the most important thing in my life”

(2)  “Conflicts have arisen between me and my family and/or my partner about the amount of time I spend on my smartphone”

(3)  “My smartphone use often gets in the way of other important things I should be doing (working, education, etc.)”

(4)  “I spend more time on my smartphone than almost any other activity”

(5)  “I use my smartphone as a way of changing my mood”

(6)   “Over time I have increased the amount of time I spend on my smartphone during the day”

(7)  “If I am unable to use my smartphone I feel moody and irritable”

(8)  “I often have strong urges to use my smartphone”

(9)  “If I cut down the amount of time I spend on my smartphone, and then start using it again, I always end up spending as much time on my smartphone as I did before”.

(10) “I have lied to other people about how much I use my smartphone”

Just remember that excessive use does not necessarily mean addiction, and the difference between a healthy enthusiasm and addiction is that healthy enthusiasms add to life, and addictions take away from them.

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

Further reading

Beranuy, M., Oberst, U., Carbonell, X., & Chamarro, A. (2009). Problematic Internet and mobile phone use and clinical symptoms in college students: The role of emotional intelligence. Computers in Human Behavior, 25, 1182–1187.

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Obert, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Carbonell, X., Guardiola, E., Beranuy, M., & Belles, A. (2009). A bibliometric analysis of the scientific literature on Internet, video games, and cell phone addiction. Journal of Medical Library Association, 97(2), 102-107.

Beranuy, M., Chamarro, A., Graner, C., & Carbonell, X. (2009). Validacion de dos escalas breves para evaluar la adiccion a Internet y el abuso de movil. Psicothema, 21, 480-485.

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

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.

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