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.

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.

No joking on smoking: My top ten tips for giving up smoking this Stoptober

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol addiction and nicotine addiction (see ‘Further reading’ below). In 2012, I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

In my previous blog I looked at ways to reduce alcohol intake as part of the ‘Go Sober For October‘ campaign. In today’s blog I provide my advice for giving up smoking as part of the annual ‘Stoptober’ campaign. In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects.

Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

• (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
• (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0300 123 1044) or visit the Smokefree website.
• (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

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

Further reading

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

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

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

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

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

What a drag: A brief look at cigarette smoking and nicotine dependence

Cigarette smoking among adults (i.e., those aged 18 years and over) has been a highly prevalent behaviour in Great Britain for decades but overall rates have significantly declined in recent times. Figures show that the highest recorded level of nicotine smoking among British males was in 1948 when four-fifths smoked (82%) although at that time only two-thirds smoked manufactured cigarettes (as the rest smoked pipes and/or cigars). The highest recorded level of nicotine smoking among British females was in the mid-1960s (45%) slightly higher than the prevalence rate of 41% in 1948.

A 2003 study by Dr. M. Jarvis in the journal Addiction reported that since 2000 the overall adult smoking rates in Great Britain had been declining by around 0.4% per year. More recently, the British prevalence rates of smoking remained constant at 21% between 2007 and 2009 (according to a 2013 report by Action on Smoking and Health [ASH]). According to the 2013 Office for National Statistics report, the most recent prevalence rate is 20% (21% of men and 19% of women). This equates to around 10 million British adult cigarette smokers. Smoking prevalence rates are highest in young adults. More specifically, in the 20-24 year age group, the prevalence rate of nicotine smoking is 30% in males and 28% in females. Only 1% of children are nicotine smokers at the age of 11 years. By the age of 15 years, 11% of children are regular smokers. As the 2013 ASH report noted:

“Since the mid 1970s cigarette consumption has fallen among both men and women. The overall reported number of cigarettes smoked per male and female smoker has changed little since the mid 1980s, averaging 13 cigarettes per smoker per day. As in previous years, men smoked slightly more per day on average than women and there was an association between consumption and socio-economic group. In 2011, smokers in manual occupations smoked an average of 14 cigarettes a day compared with 11 a day for those in managerial or professional groups… In 2011, 63% of smokers said they would like to stop smoking altogether. Other ways of measuring dependence include how difficult people would find it to go for a whole day without smoking and how soon they smoke after waking… In 2011, 60% of smokers said they would find it hard to go for a whole day without smoking. Eighty-one per cent of heavier smokers (20 or more a day) said they would find it difficult, compared to 32% of those smoking fewer than 10 cigarettes per day”.

Like drug addictions more generally, nicotine addiction is a complex combination of influences including genetic, pharmacological, psychological, social and environmental factors. In 2010, the US Surgeon General asserted that “there is no established consensus on criteria for diagnosing nicotine addiction” but that there are a number of symptoms can be viewed as addiction indicators such as:

• Drug use that is highly controlled or compulsive with psychoactive effects
• Stereotypical patterns of use
• Continued use despite harmful effects
• Relapse following abstinence accompanied by recurrent cravings.

A 2000 report by the Royal College of Physicians also noted that nicotine fulfils criteria for defining an addiction and states that:

“It is reasonable to conclude that nicotine delivered through tobacco smoke should be regarded as an addictive drug, and tobacco use as the means of self-administration…Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.”

One of the key characteristics of drug addiction or dependence on a substance is the degree of compulsion experienced by the user. Since 1992, the British General Lifestyle Survey (which typically surveys around 15,000 adults from over 9000 households annually) has asked three questions relevant to nicotine dependence and addiction. The first is whether the person would like to stop smoking, the second is whether person would find it easy or difficult not to smoke for a whole day, and the third is how soon after waking up they smoke their first cigarette. Since 1992, there has been almost no change in any of the three measures.

The latest 2013 survey reported that 63% of smokers said they would like to stop smoking altogether and 60% felt it would be difficult for them to go a day without smoking. Four-fifths (81%) of heavy smokers (i.e., those smoking 20 or more cigarettes a day) said they would find it difficult to give up smoking compared to one-third (32%) of lighter smokers (i.e., those smoking less than 10 cigarettes a day). The average number of cigarettes smoked per day is 13, and 14% smoke a cigarette within five minutes of getting up in the morning, a figure that rises to 35% among heavy smokers who smoke more than 20 cigarettes a day. Research consistently shows that approximately two-thirds of smokers want to quit the behaviour yet the majority are unable to do so, which is also suggestive of a genuine addiction. Those that do try to quit smoking typically experience a wide range of withdrawal symptoms including craving for nicotine, irritability, anxiety, difficulty concentrating, restlessness, sleep disturbances, decreased heart rate, and increased appetite or weight gain.

Outside of Great Britain, tobacco and other drug use prevalence have been examined extensively among youth and adults. For example, by the Monitoring the Future research group in the U.S. (http://monitoringthefuture.org). They reported that daily (20 or more days in last 30 days) cigarette smoking varied from 11.4% among 18 year olds to 17% among 50 year olds. One may infer that daily cigarette smoking is addictive use, though several studies measure tobacco (nicotine) addiction specifically. Tobacco addiction (dependence) among older teenagers has been found to vary between 6% and 8%. Studies have found a prevalence rates of between 1.7% to 9.6% for tobacco addiction among college students.

In a 2004 issue of the Archives of General Psychiatry, Dr. Jon Grant and colleagues found a prevalence of 12.8% for tobacco addiction among a U.S. national sample of adults. A few years later in a 2009 issue of the American Journal of Public Health, Dr. R.D. Goodwin and colleagues found a prevalence of 21.6% and 17.8% for tobacco addiction among a U.S. national sample of male and female adults, respectively. It appears that daily smoking demonstrates about the same level of prevalence as direct measures of dependence, particularly among adults.

In a 2011 study that I carried out with Dr. Steve Sussman and Nadra Lisha, we estimated that past year nicotine dependence prevalence in the general adult population of the U.S. as being approximately 15%. A different summary of research on the epidemiology of drug dependence has shown that of all people who initiate cigarette use, almost one-third become addicted smokers (32%), a figure that is much higher addiction rate than for users of heroin (23%), cocaine (17%), alcohol (15%) or cannabis (9%).

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

Further reading

Action on Smoking and Health (2012). Nicotine and addiction. London: Action on Smoking and Health.

Action on Smoking and Health (2013). Smoking statistics: Who smokes and how much. London: Action on Smoking and Health.

Benowitz, N. (2010). Nicotine addiction. New England Journal of Medicine, 362, 2295–2303,

Carpenter C.M., Wayne, G.F., & Connolly, G.N. (2007). The role of sensory perception in the development and targeting of tobacco products. Addiction, 102, 136-147.

Goodwin, R.D., Keyes, K.M., & Hasin, D.S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001-2002 wave of the National Epidemiologic Survey of Alcoholism and Related Conditions. American Journal of Public Health, 99, 1471-1477.

Grant, B.F., Hasin, D.S., Chou, P., Stinson, F.S., & Dawson, D.A. (2004a). Nicotine dependence and psychiatric disorders in the United States. Archives of General Psychiatry, 61, 1107-1115.

Information Centre for Health and Social Care (2011). Smoking drinking and drug use among young people in England in 2011. London: Information Centre for Health and Social Care.

Jarvis, M. (2003). Monitoring cigarette smoking prevalence in Britain in a timely fashion. Addiction, 98, 1569-1574.

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

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

Wald, N. & Nicolaides-Bouman, A. (1991). UK Smoking Statistics (2nd edition). Oxford: Oxford University Press.

Becoming less of a drag: The Stoptober campaign (revisited)

(The following blog is based on an article I published last year in the Nottingham Post on why I was actively supporting the Stoptober smoking campaign to get people to stop smoking for 28 days during October. I also published a blog last year outlining my 10 top tips for giving up smoking. Since that blog, my ten tips have been slightly changed and adapted in co-operation with the Department of Health running the Stoptober campaign. I make no apologies for repetition between today’s blog and that published last year, as my only aim is to help people give up smoking).

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol and nicotine addiction (see ‘Further reading’ below). Last year I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

This October, the Department of Health (DoH) are re-launching the ‘Stoptober’ campaign for the second time, urging as many nicotine smokers as possible to give up smoking for 28 days from October 1. The DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period. Like last year, those that decide to try and stop for the month will be given a lot of encouragement during the campaign including access to the Smokefree Facebook page and the downloadable Stoptober app. People will also be sent daily emails providing additional encouragement.

In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

• (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
• (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0800-1690169) or visit the smokefree website and click on the ‘ways to quit’ tab.
• (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

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

Further reading

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

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

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

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

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

Smoker face: A brief overview of capnolagnia

Watch any film or television programme made before 2000 that features a post-coital couple in bed, and odds on, one (if not both) of them will be smoking a cigarette. I started with that anecdotal observation just by way of establishing that sex and cigarette smoking are (quite literally) not so strange bedfellows. However, for a small minority of people, smoking in and of itself can be sexually arousing and for some may even be a sexual paraphilia (called capnolagnia). Dr. Anil Aggrawal in his 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices defines capnolagnia as a sexual paraphilia in which individuals derive sexual pleasure and sexual arousal from watching others smoke. The Collar ‘n’ Cuffs website adds in an article on smoking fetishism that the smoking can either be normal cigarettes or the smoking of marijuana spliffs.

The defining features of capnolagnia are outlined at the Right Diagnosis website. It is claimed that people who experience one (or more) of the following symptoms are considered to have a smoking fetish: (i) sexual interest in watching other people smoking, (ii) recurring intense sexual fantasies involving watching other people smoking, and (iii) recurring intense sexual urges involving watching other people smoking. As far as I am aware, there is almost no empirical or clinical research on capnolagnia. Given that there are no treatment papers in the clinical and medical literature it suggests that either capnolagnia is rare and/or people who have the fetish live with it happily without feeling the need to seek treatment.

Arguably, it wasn’t really until the advent of the internet in the 2000s that people were even aware that smoking fetishes even existed. As with many other fetishes, like-minded people began to meet on online newsgroups (such as early groups like alt.smokers.glamour and alt.sex.fetish.smokers) and then escalated to trading stories, pictures, videos, and (now) DVDs. The overview on Wikipedia (arguably the most in-depth overview I’ve seen on smoking fetishism) claims that (like most fetishes) it has its roots in early childhood classical conditioning where smoking becomes paired with sexual response and/or psychodynamic theories rooted in Freud’s oedipal complex.

“These could include seeing the smoker as a stereotypically sweet, innocent individual behaving in ways that are considered taboo. For others, it stems from an attraction to more worldly people whose smoking epitomizes their strength and self-confidence. Within gay culture, this fetish often stems from the image of masculinity… Another cultural source for the fetish may be eroticized depictions of women who smoke that come from older motion pictures, especially from the film noir era… it has also been speculated that men who have smoking fetishes are more likely to have mothers who smoked, going back to the old belief that all men are secretly attracted to women who are just like their mothers”.

In a short article on “bizarre” fetishes, the Religious Sex website claims that there is a “darker and more extreme version” of capnolagnia found among the BDSM [bondage, dominance, submission, masochism) and female domination subcultures in which submissive partners may be treated like a human ashtray and forced by their dominant partner to swallow cigarette ash, have cigarette smoke blown continually into their face, and/or have cigarettes stubbed out on their naked flesh. The use of the submissive here as an inanimate item has overlaps with the humiliating and masochistic world of forniphilia (i.e., use of people as human furniture for sexual pleasure) that I examined in a previous blog.

The article in Wikipedia claims most smoking fetishists are heterosexual males but that there are significant minorities of gay men and bisexual men that also enjoy the behaviour (and an even smaller number of heterosexual women). More specifically, the article claims:

“Among heterosexual men, the fetish is often associated with oral fixations and fellatio and it is rather caused by the image of the woman smoking, than by the smell. It seems that the smell and taste of the cigarettes have a greater role to play in women’s smoking behavior than in that of men. Some fetishists have a fascination with the addictive properties of nicotine, and its ability to cause harm, and there is a sub-fetish relating to women being harmed by smoking, sometimes called “the dark side”, “black lung fetish” or “lung damage”. This has been interpreted as an element of misogyny in the community’s psychology”

The article on Wikipedia claims capnolagnia among gay men differs from that among heterosexual men. It is claimed that gay men become aroused at either ‘dominant’ men smoking or young (“innocent”) men initiating smoking for the first time. According to some online female domination sites, there are other sub-types of capnolagnia (described online as “sub-fetishes”), particularly in nicotine’s potential to cause harm and sometimes called “lung damage”.

“For women this is seen in videos showing women smoking and coughing, suggesting self-destructiveness. More common videos are those showing a woman or a man in bondage, being forced to smoke or to inhale smoke. ‘Glamor’ smoking and ‘dark side’ smoking are the major divisions within the fetish. The glamor aspect of the fetish emphasizes the way smoking visually enhances women’s sexual appeal; the dark side links smoking to female domination, bondage and domination, and sadism/masochism. Both elements may be related to the appeal of the “bad girl” and the fantasy that even a “girl next door” type who smokes may be a tigress in the bedroom. A handful of producers specialize in videos appealing to one or both sides of the fetish…Ironically, as mainstream society has recognized the dangers of smoking, the effect has been to heighten interest in smoking fetishism. The more we recognize that smoking is bad for our health, the truer it becomes that only ‘bad’ girls smoke, and the more attractive they become to the smoking fetishist”.

I did a literature search on psychological databases for empirical research into capnolgania and identified only one paper that had even mentioned it. This was in a 2012 issue of the journal Tobacco Journal where the authors Dr Mary Carroll, Dr Ariel Shensa and Dr Brian Primack (all at the University of Pittsburgh, US) systematically analyzed YouTube videos with cigarette-related content. Their systematic search online yielded 66 cigarette-related videos for qualitative analysis. The researchers coded the overall portrayal of smoking as positive if the smoking was largely portrayed as attractive, fun, powerful, pleasurable, relaxing or sexy. Their findings showed that 9% of the videos analyzed contained fetishistic smoking content. Given the small sample size and the selective search methods used by the research team, we have no way of knowing if the results can be generalized.

However, I realized that after reading this paper that this was the latest in a number of studies that have looked at smoking and smoking fetish videos on YouTube (except in the previous studies no-one called it capnolagnia). For instance, an earlier study published in a 2010 issue of Nicotine and Tobacco Research, by Dr. Susan Forsyth and Dr. Ruth Malone (both at the University of California, US) examined 124 of the most popular YouTube videos about cigarette use. They reported that the videos they analyzed frequently associated cigarettes with sexual themes and commonly portrayed cigarette smoking in a positive light (however, smoking fetishism wasn’t studied in isolation).

In a 2002 issue of the Journal of Health Commerce, Dr. T. Hong and Dr. M.J. Cody conducted a content analysis study of 318 pro-tobacco websites and examined the models in the photographs displayed on these websites. They reported that female models were most often portrayed in sex/fetish sites and were slim and attractive. Similarly, in 2003 in the journal Health Education and Behavior, Dr. Kurt Ribisl and his colleagues in North Carolina (US) also conducted a content analysis of over 1600 photographs displayed on 30 smoking websites and examined the amount of smoking and nudity displayed. Five of the websites mentioned smoking fetishes and 7% of the photographs contained nudity and smoking.

Another study, in a 2007 issue of Tobacco Control by Dr. Becky Freeman and Dr. Simon Chapman (University of Sydney, Australia), examined YouTube videos with smoking content and identified those videos were most commonly watched. Perhaps unsurprisingly, the most watched pro-smoking videos were the smoking fetish and female smoking videos. Similarly, in a 2010 issue of the journal Health Communication, Dr Kyongseok Kim and colleagues conducted a content analysis of the smoking fetish videos on YouTube. Among the 139,000 videos that were located, a total of 2,220 (1.6% of all smoking videos) were smoking fetish videos. Although none of these studies tell us much about the etiology and psychology of smoking fetishes, they do tell us that there are a significant minority of smoking fetish sites out there, and that maybe capnolagnia is not as rare as first believed.

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

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Amos, A., & Haglund, M. (2000). From social taboo to “torch of freedom”: the marketing of cigarettes to women. Tobacco Control, 9, 3-8.

Carroll, M.V., Shensa, A. & Brian A Primack, B.A. (2012). A comparison of cigarette- and hookah-related videos on YouTube. Tobacco Control, doi: 10.1136/tobaccocontrol-2011-050253.

Collar ‘n’ Cuffs (2010). Smoking fetishism (capnolagnia). February 19. Located at: http://collarncuffs.com/resources/doku.php?id=capnolagnia

Forsyth, S.R. & Malone, R.E. (2010). I’ll be your cigarette-Light me up and get on with it”: Examining smoking imagery on YouTube. Nicotine and Tobacco Research, 12, 810e16.

Freeman, B., & Chapman, S. (2007). Is ‘YouTube’ telling or selling you something? Tobacco content on the YouTube video-sharing website. Tobacco Control, 16, 207-210.

Hong, T., & Cody, M. (2002). Presence of pro-tobacco messages on the Web. Journal of Health Commerce, 7, 273-307.

Kim, K., Paek, H.J. & Lynn, J. (2010). A content analysis of smoking fetish videos on YouTube: regulatory implications for tobacco control. Health Communication, 25, 97-106.

Religious Sex (2012). “Bizarre” fetishes (Part 1). Gothic Fetish, May 8. Located at: http://www.religioussex.com/bizarre-fetishes/

Ribisl, K.M., Lee, R.E., Henriksen, L., & Haladjian, H.H. (2003). A content analysis of Web sites promoting smoking culture and lifestyle. Health Education and Behavior, 30, 64-78.

Right Diagnosis (2012). Capnolagnia. February 1. Located at: http://www.rightdiagnosis.com/c/capnolagnia/intro.htm

Wikipedia (2012). Smoking fetishism. Located at: http://en.wikipedia.org/wiki/Smoking_fetishism

That smoke isn’t funny any more: Nicotine addiction and the ‘Stoptober’ campaign

Although most of my academic research is on behavioural addiction, I do publish the odd paper here and there are on more traditional addictions such as alcohol and nicotine addiction (particularly in relation to the relationship to behaviours like gambling). Over the last few months (on a personal rather than level) I have thought a lot about nicotine addiction as I have had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died last Saturday (September 8th, 2012 aged 66 years) and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease (aged 54 years).

Last week, the British government’s Department of Health (DoH) launched the ‘Stoptober’ campaign urging as many nicotine smokers as possible to give up smoking for 28 days from October 1st. This is the first time ever that such an innovative campaign has been launched on a national basis, and the DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period (I’m not sure on what empirical evidence that is based but it sounds reasonable). Those that decide to try and stop for the month will be given a lot of encouragement during the four-week period including access to the Smokefree Facebook page, and a downloadable Stoptober app. Those signing up to stop will also be sent daily emails providing additional encouragement. At present in the UK, smoking accounts for approximately one in four cancer deaths (and as I said, it’s something I’ve witnessed first hand).

I’m sure most people reading this are aware of the addictive nature of nicotine (it was one of the main reasons why my parents were never able to stop). As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within 10 seconds (and stimulates the release of the neurotransmitter dopamine). The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette.

For those of you out there with an addiction to nicotine, I thought I would provide my 10 golden tips that may help you in taking steps towards giving up for good. The tips are not foolproof and I failed with my own parents. However, that doesn’t mean you shouldn’t give it a go.

• Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• Get all the emotional support you can get: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. Gradually cutting down the number of cigarettes smoked per day is a good starting strategy.
• Use nicotine replacements: Cutting out nicotine completely is hard, so consider using some kind of nicotine replacement. Nicotine patches, chewing gums, and lozenges will help inhibit the cravings and will help you stabilize your behaviour.
• Use non-nicotine shaped cigarette substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• Know the triggers for your smoking: Knowing the situations that you tend to smoke can help in overcoming the urges to smoke. Lighting up a cigarette can sometimes be the result of a classically conditioned response (e.g., having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g., chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g., alcohol) or activities (e.g., gambling).

Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, you can find the incentives you need to help you give up permanently.

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

Further reading

BBC News (2012). ‘Stoptober’ stop-smoking campaign launched in England. BBC Health News, September 8. Located at: http://www.bbc.co.uk/news/health-19506327

Department of Health (2012). Stoptober campaign will encourage smokers to quit for 28 days. September 8. Located at: http://www.dh.gov.uk/health/2012/09/stoptober/

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

Griffiths, M.D. (1994). Co-existent fruit machine addiction and solvent abuse in adolescence: A cause for concern? Journal of Adolescence, 17, 491-498.

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

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

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

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.