Spinal rap: A brief look at my surgical recovery (so far) – Part 1

On April 15 I had an operation to decompress my spinal cord and to have the C5 disc in my neck replaced with a new titanium disc. I ended up in hospital for 67 days. Here’s the back story (no pun intended). 

For the past 18 years I have lived with a compressed spinal cord. Although I had the condition since 2003, it wasn’t diagnosed until an MRI scan in 2007. The scan showed that the C5 disc in my neck was completely herniated and that the disc was pressing directly onto my spinal cord causing hundreds of electric shocks every single day. I was prescribed daily amitriptyline which significantly reduced the number of shocks I felt. I was also prescribed heavy duty painkillers (dihydrocodeine) but I soon realised that work was the best analgesic in the world. Instead of taking up to four doses of dihydrocodeine every day, I worked (and worked). I rarely took more than four doses of dihydrocodeine a year let alone a day. I was also given details of an operation I could have but just the very thought of it scared me – especially because of the risk of being left paralysed from the neck or chest down. I was told to come back if I changed my mind about having an operation. 

I am not 100% sure what caused the complete herniation of the disc in my neck but I suspect it was a minor traffic collision I was involved in at the beginning of November 2003. I was sitting on the front seat on the top floor of a double decker bus when a taxi crashed into the right-hand side of the bus and I was propelled forward onto the bus’s front window where my head hit the glass window, smashed the glasses I was wearing, and left me concussed. I was highly stressed that day because I was on my way to have a CT scan to look at swollen lumps in my throat for suspected Hodgkin’s or non-Hodgkin’s lymphoma. Later that week I had a lymphadenectomy and the biopsy showed that I didn’t have cancer but was diagnosed with toxoplasma lymphadenitis. It was after this operation that I began to get the constant daily electric shocks (over 100 a day) every time I moved my neck. I assumed that the constant electric shocks were as a result of my operation but I was later told that the shocks were being caused by a compressed spinal cord and that my lymphadenectomy was not the cause.

Over the next decade or so, the pain caused the constant compression of my spinal cord got progressively worse. Walking became increasingly difficult but I used excessive work as the strategy to suppress the increasing physical pain. In short, work became the perfect distractor task. When I was 100% cognitively engaged (e.g., giving a paper or teaching, writing or editing papers, etc.) I was in no pain whatsoever. I returned to the workaholic tendencies that I had before I had children. One of my consultants also described me as having “unspent youthfulness” which masked my medical condition for years. 

The lifestyle I was leading in the years leading up to my operation probably didn’t help. I was travelling excessively averaging 20-25 overseas trips a year for conferences, consultancy, and research meetings. Walking became increasingly difficult as I was unable to lift my right foot properly. During 2019, I had a number of really bad falls abroad (tripping over because my right foot wouldn’t lift) including three in Abu Dhabi and a couple in Auckland which left me with horrendous bursitis on both of my elbows. 

During the lockdown period, my health deteriorated badly. I was not globe-trotting anymore and I was housebound for over a year. My working life (and social life) became increasingly sedentary. I was doing everything from home including all my teaching. I had not stepped foot in my university office since the end of February 2020 (and still haven’t).

In August 2020, I saw one of my consultants and told him that my health condition had got significantly worse and that I now wanted the operation. However, because my surgery was classed as ‘elective’ as opposed to ‘urgent’ a date for surgery never came as the Nottingham hospitals were full of very ill COVID-19 patients. At one point during the pandemic, Nottingham was the UK city with the most COVID-19 infections. By February 2020 I could hardly walk and was becoming increasingly immobile. I rang my consultant’s secretary every week asking if I could have an appointment. I finally got one at the end of March 2021 and after seeing how bad my mobility was, I got an operation date very quickly. Thursday April 15, 2021. I was told by my consultant who was performing the surgery that he expected my to be back home the next day if the surgery was successful.

I have to be honest and say that the operation still scared me. Although there was a small chance of dying, that didn’t worry me. It was the thought of waking up paralysed which dominated my thoughts for over a week prior to the operation. Loss of limb use. Loss of job and livelihood Loss of identity. Loss of salary. There are many risks with any operation but spinal surgery carries many extra risks. I was told that some of the consequences could be eating and drinking difficulties and voice loss (as they would be carrying out the surgical procedure through the front of my neck and having to decompress my spinal cord by going via my trachea and oesophagus). I told my consultant that I would rather be dead than paralysed from the chest or neck down.

As the day of the operation approached, I again used work to block out my fears and negative thoughts. On April 15, my partner dropped me off at the hospital at 7am in the morning. Before my operation I had talks with the anaesthetist and one of the surgical team. I then had to sign the consent form which included a very long list of all the things that could go wrong. However, the weeks prior to my operation were surviving not living. I felt I was in the last chance saloon.

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

World of the Weird: The A-Z of strange and bizarre addictions

Today’s blog takes a brief look at some of the stranger addictions that have been written about in the academic literature (or academics that have tried to argue these behaviours can be addictive). Some of these ‘addictions’ listed are not addictions by my own criteria but others have argued they are. The papers or books that have argued the case for the cited behaviour being a type of addiction are found in the ‘Further reading’ section.

• Argentine tango addiction: A French study published in a 2013 issue of the Journal of Behavioral Addictions by Remi Targhetta and colleagues argued that a minority of 1129 Argentine tango dancers they surveyed may be addicted to dancing. In 2015, I and some of my Hungarian colleagues developed the Dance Addiction Inventory (published in PLoS ONE) and also argued that a minority of dancers (more generally) might be addicted to dance and conceptualized the behaviour as a form of exercise addiction.
• Badminton addiction: While there are many behaviours I could have chosen here including addictions to box set television watching (aka ‘box set bingeing), bargain hunting, bungee jumping, blogging, and bodybuilding, a recent 2018 paper published in NeuroQuantology by Minji Kwon and colleagues carried out a neuroimaging study on a sample 45 badminton players. Using the Korean Exercise Addiction Scale, 20% of the sample were defined as being addicted to badminton.
• Carrot eating addiction: Again, there are many behaviours I could have chosen here including alleged addictions to crypto-trading, chaos, collecting, crosswords, and cycling, there are a number of published case studies in the psychological literature highlighting individuals addicted to eating carrots including papers by Ludek Černý and Karel Černý, K. (British Journal of Addiction, 1992), and Robert Kaplan (Australian and New Zealand Journal of Psychiatry, 1996).
• Death addiction: A recent paper by Dr. Marc Reisinger entitled ‘Addiction to death’ in the journal CNS Spectrums attempted to argue that attraction to death be considered an addiction similar to gambling addiction. Reisinger related the concept to individuals who have left Europe to join the jihad in Syria, and outlined the case of 24-year-old French-Algerian Mohamed Merah who committed several attacks in Toulouse in 2012 and who ‘glorified’ death. Te paper claimed that this “addiction to death is taught by Salafist preachers, whose videos, readily accessible on the internet, are kind of advertisements for death, complete with depictions of soothing fountains and beautiful young girls”.
• Entrepreneurship addiction: There are a couple of papers by April Spivack and Alexander McKelvie (a 2014 paper in the Journal of Business Venturing, and a 2018 paper Academy of Management) arguing that entrepreneurship can be addictive. They define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. They also make the case that that entrepreneurship addiction is different from workaholism.
• Fortune telling addiction: Although I could have included addictions to financial trading or fame, a 2015 paper in the Journal of Behavioral Addictions by Marie Grall-Bronnec and her colleagues reported the case study of a woman (Helen) that was ‘addicted’ to fortune tellers. They used my addiction criteria to assess whether Helen was addicted to fortune telling, and argued that she was.
• Google Glass addiction: In previous blogs I have written on addictions to gossip and gardening (although these were based more on non-academic literature). However, a 2015 paper published by Kathryn Yung and her colleagues in the journal Addictive Behaviors, published the first (and to my knowledge) only case of addiction to Google Glass (wearable computer-aided glasses with Bluetooth connectivity to internet-ready devices. The authors claimed that their paper, (i) showed that excessive and problematic uses of Google Glasscan be associated with involuntary movements to the temple area and short-term memory problems, and (ii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass.
• Hacking addiction: Back in the late 1990s and early 2000s I wrote a number of papers on internet addiction and included ‘hacking addiction’ as a type of internet addiction. Given the criminal element of this type of internet addiction I wrote about it in criminological-based journals such as The Probation Journal (1997) and The Police Journal (2000). One of the most infamous cases that I have written about took place in London in 1993, where Paul Bedworth was accused of hacking-related crime causing over £500,000 worth of damage. On the basis of expert witness testimony, he was acquitted on the basis that he was addicted to hacking. Since then, various papers have been published arguing that hacking can be an addiction. For instance, in an in-depth interview study of 62 hackers, Siew Chan and Lee Yao used addiction as a framework to explain their participants’ behaviour (see their paper in the Review of Business Information Systems, 2005).
• Internet search addiction: Although I was tempted to go for IVF addiction, I thought I would go for ‘internet search addiction’ which basically refers to constant ‘googling’ where individuals spend hours and hours every day using online databases to go searching for things. This behaviour was first alluded to by Kimberley Young in her 1999 classification of different types of internet addiction which she called ‘information overload’ and was defined as compulsive web surfing or database searches. More recently, Yifan Wang and her colleagues developed the Questionnaire on Internet Search Dependence (QISD) published in Frontiers in Public Health (FiPH). I criticized the QISD in a response paper published in FiPH, not because I didn’t think internet search addiction didn’t exist (because theoretically it might do, even though I’ve never come across a genuine case) but because the items in the instrument had very little to do with addiction.
• Joyriding addiction: There have been a number of academic papers published on joyriding addiction. Arguably the most well-known study was published by Sue Kellett and Harriet Gross in a 2006 issue of Psychology, Crime and Law. The study comprised semi-structured interviews with 54 joyriders (aged 15 to 21 years of age) all of whom were convicted car thieves (“mainly in custodial care”). The results of the study indicated that all addiction criteria occurred within the joyriders’ accounts of their behaviour particularly ‘‘persistence despite knowledge and concern about the harmful consequences’’, ‘‘tolerance’’, ‘‘persistent desire and/or unsuccessful attempts to stop’’, “large amounts of time being spent thinking about and/or recovering from the behaviour’’ and “loss of control”. The paper also cited examples of ‘withdrawal’ symptoms when not joyriding, the giving up of other important activities so that they could go joyriding instead, and spending more time participating in joyriding than they had originally intended.
• Killing addiction: The idea of serial killing being conceptualized as an addiction in popular culture is not new. For instance, Brian Masters book about British serial killer Dennis Nilsen (who killed at least 12 young men) was entitled Killing for Company: The Story of a Man Addicted to Murder, and Mikaela Sitford’s book about Harold Shipman, the British GP who killed over 200 people, was entitled Addicted to Murder: The True Story of Dr. Harold Shipman. In Eric Hickey’s 2010 book Serial Murderers and Their Victims, Hickey makes reference to an unpublished 1990 monograph by Dr. Victor Cline who outlined a four-factor addiction syndrome in relation to sexual serial killers who (so-called ‘lust murderers’ that I examined in a previous blog). One of the things that I have always argued throughout my career, is that someone cannot become addicted to an activity or a substance unless they are constantly being rewarded (either by continual positive and/or negative reinforcement). Given that serial killing is a discontinuous activity (i.e., it happens relatively infrequently rather than every hour or day) how could killing be an addiction? One answer is that the act of killing is part of the wider behaviour in that the preoccupation with killing can also include the re-enacting of past kills and the keeping of ‘trophies’ from the victims (which I overviewed in a previous blog).
• Love addiction: In the psychological literature, the concept of love addiction has been around for some time dating back to works by Sigmund Freud. Arguably the most cited work in this area is the 1975 book Love and Addiction by Stanton Peele and Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. There have also been a number of instruments developed assessing love addiction including the Love Addiction Scale (developed by Hunter, Nitschke, and Hogan, 1981), and the Passionate Love Scale (developed by Hatfield, and Sprecher, 1986).
• Muscle dysmporphia as an addiction: In a paper I published with Andrew Foster and Gillian Shorter in a 2015 issue of the Journal of Behavioral Addictions, we argued that muscle dysmorphia (MD) could be classed as an addiction. MD is a condition characterised by a misconstrued body image in individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a body dysmorphic disorder, an eating disorder, and/or part of the obsessive-compulsive disorder symptomatology. Reviewing the most salient literature on MD, we proposed an alternative classification of MD that we termed the ‘Addiction to Body Image’ (ABI) model. We argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating specific foods, taking specific drugs (e.g., anabolic steroids), shopping for specific foods, food supplements, and/or physical exercise accessories, etc.. In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Based on empirical evidence, we proposed that MD could be re-classed as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.
• News addiction: Although I could have chosen nasal spray addiction or near death addiction, a recent 2017 paper on ‘news addiction’ was published in the Journal of the Dow University of Health Sciences Karachi by Ghulam Ishaq and colleagues. The authors used some of my papers on behavioural addiction to argue for the construct of ‘news addiction’ as a construct to be empirically investigated. The authors also developed their own 19-item News Addiction Scale (NAS) although the paper didn’t give any examples of any of the items in the NAS. In relation to personality types (and like other addictions), they found news addiction was positively correlated with neuroticism and negatively correlated with conscientiousness. Given that this is the only study on news addiction that I am aware of, I’ll need a lot more research evidence before I am convinced that it really exists.
• Online auction addiction: A number of academics have made the claim that some individuals can become addicted to participating in online auctions. In a 2004 paper on internet addiction published in American Behavioral Scientist, Kimberley Young mentioned online auction [eBay] addiction in passing. The same observation was also made in a later 2009 paper by Tonino Cantelmi and Massimo Talls in the Journal of CyberTherapy and Rehabilitation. Other researchers have carried out empirical studies including a (i) 2007 paper by Cara Peters and Charles Bodkin in the Journal of Retailing and Consumer Services, (ii) 2008 paper by Chih-Chien Wang in the Proceedings of the Asia-Pacific Services Computing Conference, and (iii) 2011 study carried out by Dr. Ofir Turel and colleagues published in the MIS Quarerly. These papers indicated that those with problematic online auction use experienced (i) psychological distress, (ii) habitual usage, (iii) compulsive behaviour, (iv) negative consequences, and/or (v) dependence, withdrawal and self-regulation.
• Pinball addiction: Although I could have listed alleged addictions to plastic surgery and poetry, as far as I am aware, I am the only academic to have published a paper on pinball addiction. Back in 1992, I published a case study in Psychological Reports. My paper featured the case of a young man (aged 25 years) who (based on classic addiction criteria) was totally hooked on pinball. It was the most important thing in his life, used the behaviour to modify his moods, got withdrawal symptoms if he was unable to play pinball, had engaged in repeated efforts to cut down or stop playing pinball, and compromised all other activities in his life (education, occupation and relationships). To me, this individual had a gaming addiction but it was pinball rather than videogame addiction.
• Qat addiction: Qat (sometimes known as khat, kat, cat, and ghat) is a flowering plant traditionally used as a mild stimulant in African and Middle East countries (Somalia, Yemen, Ethiopia). Heavy qat users can experience many side effects including insomnia, anxiety, increased aggression, high blood pressure, and heart problems. There are numerous reports in the medical literature of qat addiction (see papers by Rita Manghi and colleagues in the Journal of Psychoactive Drugs, and Nezar Al-Hebshi and Nils Skuag in Addiction Biology).
• Rock climbing addiction: Over the past two years, a couple of papers by Robert Heirene, David Shearer, and Gareth Roderique-Davies have looked at the addictive properties of rock climbing specifically concentrating on withdrawal symptoms and craving. In the first paper on withdrawal symptoms published in 2016 in the Journal of Behavioral Addictions, the authors highlighted some previous research suggesting that there are similarities in the phenomenology of substance-related addictions and extreme sports (in this case rock climbing). The study concluded that based on self-report, rock climbers experienced genuine withdrawal symptoms during abstinence from climbing and that these were comparable to individuals with substance and other behavioural addictions. In a second investigation just published in Frontiers in Psychology, the same team reported the development of the Rock Climbing Craving Questionnaire comprising three factors (‘positive reinforcement’, ‘negative reinforcement’ and ‘urge to climb’).
• Study addiction: I was spoilt for choice on the letter ‘S’ and could have mentioned addictions to speeding, selfie-taking, shoplifting, Sudoko, and stock market speculation. However, there are now a number of published papers on ‘study addiction’ (individuals addicted to their academic study), three of which I have co-authored (all in the Journal of Behavioral Addictions and led by my colleague Pawel Atroszko). We have conceptualised study addiction as a type of work addiction (or a pre-cursor to work addiction) and in a series of studies (including longitudinal research) we have found empirical evidence of ‘study addiction’. Italian researchers (Yura Loscalzo and Marco Giannini) have also published research on ‘overstudying’ and ‘studyholism’ too (in the journals ARC Journal of Psychiatry, 2017; Social Indicators Research, 2018).
• Tanning addiction: There is now lots of empirical research examining ‘tanorexia’ (individuals who crave tanning and spend every day on sunbeds). However, I along with my colleagues in Norway recently reconceptualised tanorexia as a ‘tanning addiction’ and developed a scale to assess it (which was recently published in a 2018 issue of the British Journal of Dermatology). Our study was the largest over study on tanning (over 23,000 participants) and our newly developed scale (the Bergen Tanning Addiction Scale) had good psychometric properties.
• Upskirting addiction: Upskirting refers to taking a photograph (typically with a smartphone) up someone’s skirt without their permission. In the UK there have been a number of high profile court cases including Paul Appleby who managed to take 9000 upskirting photos in the space of just five weeks (suggesting that he was doing it all day every day to have taken so many photos), and Andrew MacRae who had amassed 49,000 upskirt photos and videos using hidden cameras at his workplace, on trains, and at the beach. Both men avoided a custodial sentence because their lawyers argued they were addicted and/or had a compulsion to upskirting. In a 2017 issue of the Law Gazette, forensic psychologist Julia Lam made countless references to upskirting in an overview of voyeuristic disorder. Dr. Lam also talked about her treatment of upskirting voyeurs and recounted one case which she claimed was a compulsion (and who was successfully treated). The case involved a male university student who was very sport active but who masturbated excessively whenever major sporting events or important exams were imminent as a coping strategy to relieve stress.
• Virtual reality addiction: Back in 1995, in a paper I entitled ‘Technological addictions’ in the journal Clinical Psychology Forum, I asserted that addiction to virtual reality would be something that psychologists would be seeing more of in the future. Although I wrote the paper over 20 years ago, there is still little empirical evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself). Of all the behaviours on this list, this is the one where there is less good evidence for its existence. Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.
• Water addiction: In a blog I wrote back in 2015, I recounted some press stories on individuals who claimed they were ‘addicted’ to drinking water. My research into the topic led to a case study of ‘water dependence’ published a 1973 issue of the British Journal of Addiction by E.L. Edelstein. This paper reported that the excessive drinking of water can dilute electrolytes in an individual’s brain and cause intoxication. This led me to a condition called polydipsia (which in practical terms means drinking more than three litres of water a day) which often goes hand-in-hand with hyponatraemia (i.e., low sodium concentration in the blood) and in extreme cases can lead to excessive water drinkers slipping into a coma. There are also dozens and dozens of academic papers on psychogenic polydipsia (PPD). A paper by Dr. Brian Dundas and colleagues in a 2007 issue of Current Psychiatry Reports noted that PPD is a clinical syndrome characterized by polyuria (constantly going to the toilet) and polydipsia (constantly drinking too much water), and is common among individuals with psychiatric disorders. A 2000 study in European Psychiatry by E. Mercier-Guidez and G. Loas examined water intoxication in 353 French psychiatric inpatients. They reported that water intoxication can lead to irreversible brain damage and that around one-fifth of deaths among schizophrenics below the age of 53 years are caused this way. Whether ‘water intoxication’ is a symptom of being ‘addicted’ to water depends upon the definition of addiction being used.
• X-ray addiction: OK, this one’s a little bit of a cheat but what I really wanted to concentrate on what has been unofficially termed factitious disorder (FD). According to Kamil Jaghab and colleagues in a 2006 issue of the Psychiatry journal “FD is sometimes referred to as hospital addiction, pathomimia, or polysurgical addiction”. The primary characteristic of people suffering from FD is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). It is called a factitious because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Again, whether such behaviours can be viewed as an addiction depends upon the definition of addiction being used.
• YouTube addiction: I unexpectedly found my research on internet addiction being cited in a news article by Paula Gaita on compulsive viewing of YouTube videos (‘Does compulsive YouTube viewing qualify as addiction?‘). The article was actually reporting a case study from a different news article published by PBS NewsHour by science correspondent Lesley McClurg (‘After compulsively watching YouTube, teenage girl lands in rehab for digital addiction’). The story profiled a student whose obsessive viewing of YouTube content led to extreme behaviour changes and eventually, depression and a suicide attempt. Not long after this, I and my colleague Janarthanan Balakrishnan published what we believe is the only ever study on YouTube addiction in the Journal of Behavioral Addictions. In a study of over 400 YouTube users we found that YouTube addiction was more associated with content creation than watching content
• ‘Zedding’ addiction: OK, I’m using the Urban Dictionary’s synonym here as a way of including ‘sleep addiction’. The term ‘sleep addiction’ is sometimes used to describe the behavior of individuals who sleep too much. Conditions such as hypersomnia (the opposite of insomnia) has been referred to ‘sleeping addiction’ (in the populist literature at least). In a 2010 issue of the Rhode Island Medical Journal, Stanley Aronson wrote a short article entitled “Those esoteric, exoteric and fantabulous diagnoses” and listed clinomania as the compulsion to stay in bed. Given the use of the word ‘compulsive’ in this definition, there is an argument to consider clinomania as an addiction or at least a behaviour with addictive type elements.

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

Further reading

Al‐Hebshi, N., & Skaug, N. (2005). Khat (Catha edulis) – An updated review. Addiction Biology, 10(4), 299-307.

Andreassen, C.S., Pallesen, S. Torsheim, T., Demetrovics, Z. & Griffiths, M.D. (2018). Tanning addiction: Conceptualization, assessment, and correlates. British Journal of Dermatology. doi: 10.1111/bjd.16480

Aronson, S. M. (2010). Those esoteric, exoteric and fantabulous diagnoses. Rhode Island Medical Journal, 93(5), 163.

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

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D., Pallesen, S. (2016). The relationship between study addiction and work addiction: A cross-cultural longitudinal study. Journal of Behavioral Addiction, 5, 708–714.

Balakrishnan, J. & Griffiths, M.D. (2017). Social media addiction: What is the role of content in YouTube? Journal of Behavioral Addictions, 6, 364-377.

Black, D., Belsare, G., & Schlosser, S. (1999). Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. Journal of Clinical Psychiatry, 60, 839-843.

Burn, C. (2016). Poesegraphilia – Addiction to the act of writing poetry. Poetry Changes Lives, May 27. Located at: http://www.poetrychangeslives.com/addiction-to-the-act-of-writing-poetry/

Cantelmi, T & Talls, M. (2009). Trapped in the web: The psychopathology of cyberspace. Journal of CyberTherapy and Rehabilitation, 2, 337-350.

Černý, L. & Černý, K. (1992). Can carrots be addictive? An extraordinary form of drug dependence. British Journal of Addiction, 87, 1195-1197.

Chan, S. H., & Yao, L. J. (2005). An empirical investigation of hacking behavior. The Review of Business Information Systems, 9(4), 42-58.

Daily Mail (2005). Aquaholics: Addicted to drinking water. May 16. Located at: http://www.dailymail.co.uk/health/article-348917/Aquaholics-Addicted-drinking-water.html

de Leon, J., Verghese, C., Tracy, J. I., Josiassen, R. C., & Simpson, G. M. (1994). Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature. Biological Psychiatry, 35(6), 408-419.

Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia review: etiology, differential, and treatment. Current Psychiatry Reports, 9(3), 236-241.

Edelstein, E.L. (1973). A case of water dependence. British Journal of Addiction to Alcohol and Other Drugs, 68, 365–367.

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

Gaita, P. (2017). Does compulsive YouTube viewing qualify as addiction? The Fix, May 19. Located at: https://www.thefix.com/does-compulsive-youtube-viewing-qualify-addiction

Grall-Bronnec, M. Bulteau, S., Victorri-Vigneau, C., Bouju, G. & Sauvaget, A. (2015). Fortune telling addiction: Unfortunately a serious topic about a case report. Journal of Behavioral Addiction, 4, 27-31.

Griffiths, M.D. (1992). Pinball wizard: A case study of a pinball addict. Psychological Reports, 71, 160-162.

Griffiths, M.D. (2000). Computer crime and hacking: A serious issue for the police. Police Journal, 73, 18-24.

Griffiths, M.D. (2017). Commentary: Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 5, 95. doi: 10.3389/fpubh.2017.00095

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

Hatfield, E., & Sprecher, S. (1998). The passionate love scale. In Fisher, T.D., Davis, C.M., Yarber, W.L. & Davis, S. (Eds.). Handbook of sexuality-related measures (pp. 449-451). London: Sage.

Heirene, R. M., Shearer, D., Roderique-Davies, G., & Mellalieu, S. D. (2016). Addiction in extreme sports: An exploration of withdrawal states in rock climbers. Journal of Behavioral Addictions, 5(2), 332-341.

Hickey, E.W. (2010). Serial Murderers and Their Victims (Fifth Edition). Pacific Grove, CA: Brooks/Cole.

Hunter, M. S., Nitschke, C., & Hogan, L. 1981. A scale to measure love addiction. Psychological Reports, 48, 582-582.

Ishaq, G., Rafique, R., & Asif, M. (2017). Personality traits and news addiction: Mediating role of self-control. Journal of Dow University of Health Sciences, 11(2), 31-53.

Jaghab, K., Skodnek, K. B., & Padder, T. A. (2006). Munchausen’s syndrome and other factitious disorders in children: Case series and literature review. Psychiatry (Edgmont), 3(3), 46-55.

Kaplan, R. (1996), Carrot addiction. Australian and New Zealand Journal of Psychiatry, 30, 698-700.

Kellett, S.  & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders’ accounts of their car crime. Psychology, Crime & Law, 12, 39-59.

Kennedy, J. G., Teague, J., & Fairbanks, L. (1980). Qat use in North Yemen and the problem of addiction: a study in medical anthropology. Culture, medicine and psychiatry, 4(4), 311-344.

Kwon, M., Kim, Y., Kim, H., & Kim, J. (2018). Does sport addiction enhance frontal executive function? The case of badminton. NeuroQuantology, 16(6), 13-21.

Lam, J. (2017). Fifty shades of sexual offending – Part 1. The Law Gazette, July. Located at: http://v1.lawgazette.com.sg/2017-07/1910.htm

Loscalzo, Y, & Giannini, M. (2017).  Evaluating the overstudy climate at school and in the family: The Overstudy Climate Scale (OCS). ARC Journal of Psychiatry, 2(3), 5-10.

Loscalzo, Y., & Giannini, M. (2018). Study engagement in Italian university students: A Confirmatory Factor Analysis of the Utrecht Work Engagement Scale—Student Version. Social Indicators Research, Epub ahead of print. https://doi.org/10.1007/s11205-018-1943-y

Manghi, R. A., Broers, B., Khan, R., Benguettat, D., Khazaal, Y., & Zullino, D. F. (2009). Khat use: lifestyle or addiction? Journal of Psychoactive Drugs, 41(1), 1-10.

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

Masters, B. (1986). Killing for Company: The Story of a Man Addicted to Murder. New York: Stein and Day.

McClurg, L. (2017). After compulsively watching YouTube, teenage girl lands in rehab for ‘digital addiction’. PBS Newshour, May 16. Located at: http://www.pbs.org/newshour/rundown/compulsively-watching-youtube-teenage-girl-lands-rehab-digital-addiction/

Menninger, K. A. (1934). Polysurgery and polysurgical addiction. The Psychoanalytic Quarterly, 3(2), 173-199.

Mercier-Guidez, E., & Loas, G. (2000). Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. European Psychiatry, 15(5), 306-311.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Peters, C.  & Bodkin, C.D. (2007). An exploratory investigation of problematic online auction behaviors: Experiences of eBay users. Journal of Retailing and Consumer Services, 14(1), 1-16.

Reisinger, M. (2018). Addiction to death. CNS Spectrums, 23(2), 166-169.

Relangi, K. (2012). Gossip, the ugly addiction. Purple Room Healing, June 12. Located at: https://deadmanswill.wordpress.com/2012/06/02/gossip-the-ugly-addiction/

Roderique-Davies, G. R. D., Heirene, R. M., Mellalieu, S., & Shearer, D. A. (2018). Development and initial validation of a rock climbing craving questionnaire (RCCQ). Frontiers in Psychology, 9, 204. doi: 10.3389/fpsyg.2018.00204

Sitford, M. (2000). Addicted to Murder: The True Story of Dr. Harold Shipman. London: Virgin Publishing.

Sparrow, P. & Griffiths, M.D. (1997). Crime and IT: Hacking and pornography on the internet. Probation Journal, 44, 144-147.

Spivack, A., & McKelvie, A. (2018). Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns. The Academy of Management Perspectives. https://doi.org/10.5465/amp.2016.0185

Spivack, A. J., McKelvie, A., & Haynie, J. M. (2014). Habitual entrepreneurs: Possible cases of entrepreneurship addiction? Journal of Business Venturing, 29(5), 651-667.

Targhetta, R., Nalpas, B. & Perney, P. (2013). Argentine tango: Another behavioral addiction? Journal of Behavioral Addictions, 2, 179-186.

Turel, O., Serenko, A. & Giles, P. (2011). Integrating technology addiction and use: An empirical investigation of online auction users. MIS Quarterly, 35, 1043-1061.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2017). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Wang, C-C. (2008). The influence of passion and compulsive buying on online auction addiction. Proceedings of the Asia-Pacific Services Computing Conference (pp. 1187 – 1192). IEEE.

Wang, Y., Wu, L., Zhou, H., Xu, J. & Dong, G. (2016). Development and validation of a self-reported Questionnaire for Measuring Internet Search Dependence. Frontiers in Public Health, 4, 274. doi: 10.3389/fpubh.2016.00274

Wright, M. R. (1986). Surgical addiction: A complication of modern surgery? Archives of Otolaryngology–Head & Neck Surgery, 112(8), 870-872.

Wulfsohn, I. (2013). A dangerous addiction: Qat and its draining of Yemen’s water, economy, and people. Middle East Economy, 3(10), 1-5.

Young, K. S. (1999). Internet addiction: Evaluation and treatment. Student British Medical Journal, 7, 351-352.

Young, K. S. (2004). Internet addiction: A new clinical phenomenon and its consequences. American Behavioral Scientist, 48, 402–415.

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, 41, 58-60.

We can work it out: A brief look at ‘entrepreneurship addiction’

Last month, a paper appeared online in the journal Academy of Management (AJM). I’d never heard of the journal before but its remit is “publish empirical research that tests, extends, or builds management theory and contributes to management practice”. The paper I came across was entitled ‘Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns’ – and is an addiction that I’d never heard of before. The authors of the paper – April Spivack and Alexander McKelvie – define ‘entrepreneurship addiction’ as “the excessive or compulsive engagement in entrepreneurial activities that results in a variety of social, emotional, and/or physiological problems and that despite the development of these problems, the entrepreneur is unable to resist the compulsion to engage in entrepreneurial activities”. Going by the title of the paper alone, I assumed ‘entrepreneurship addiction’ was another name for ‘work addiction’ or ‘workaholism’ but the authors state:

“We address what is unique about this type of behavioral addiction compared to related work pattern concepts of workaholism, entrepreneurial passion, and work engagement. We identify new and promising areas to expand understanding of what factors lead to entrepreneurship addiction, what entrepreneurship addiction leads to, how to effectively study entrepreneurship addiction, and other applications where entrepreneurship addiction might be relevant to study. These help to set a research agenda that more fully addresses a potential ‘dark side’ psychological factor among some entrepreneurs”.

The paper is a theoretical paper and doesn’t include any primary data collection. The authors had published a previous 2014 paper in the Journal of Business Venturing, on the same topic (‘Habitual entrepreneurs: Possible cases of entrepreneurship addiction?’) based on case study interviews with two habitual entrepreneurs. In that paper the authors argued that addiction symptoms can manifest in the entrepreneurial context. Much of the two papers uses the ‘workaholism’ literature to ground the term but the authors do view ‘entrepreneurship addiction’ and ‘work addiction’ as two separate entities (although my own view is that entrepreneurship addiction’ is a sub-type of ‘work addiction’ based on what I’ve read – in fact I would argue that all ‘entrepreneurship addicts’ are work addicts but not all work addicts are ‘entrepreneurship addicts’). Spivak and McKelvie are right to assert that “entrepreneurship addiction is a relatively new term and represents an emerging area of inquiry” and that “reliable prevalence rates are currently unknown”.

The aim of the AJM paper is to “situate entrepreneurship addiction as a distinct concept” and to examine entrepreneurship addiction in relation to other similar work patterns (i.e., workaholism, work engagement, and entrepreneurial passion). Like my own six component model of addiction, Spivak and McKelvie also have six components (and are similar to my own) which are presented below verbatim from their AJM paper:

• Obsessive thoughts – constantly thinking about the behavior and continually searching for novelties within the behavior;
• Withdrawal/engagement cycles – feeling anticipation and undertaking ritualized behavior, experiencing anxiety or tension when away, and giving into a compulsion to engage in the behavior whenever possible;
• Self-worth – viewing the behavior as the main source of self-worth;
• Tolerance – making increasing resource (e.g., time and money) investments;
• Neglect – disregarding or abandoning previously important friends and activities;
• Negative outcomes – experiencing negative emotional outcomes (e.g., guilt, lying, and withholding information about the behavior from others), increased or high levels of strain, and negative physiological/health outcomes.

As in my own writings on work addiction (see ‘Further reading’ below), Spivak and McKelvie also note that even when addicted, there may still be some positive outcomes and/or benefits from such behaviour (as can be found in other behavioural addictions such as exercise addiction). As noted in the AJM paper:

“Some of these positive outcomes may include benefits to the business venture including quick responsiveness to competitive pressures or customer demands and high levels of innovation, while benefits to the individual may include high levels of autonomy, financial security, and job satisfaction. It is the complexity of these relationships, or the combined positive and negative outcomes, that may obscure the dysfunctional dark side elements of entrepreneurship addiction”.

Spivak and McKelvie also go to great lengths to differentiate entrepreneurship addiction from workaholism (although I ought to point out, I have recently argued in a paper in the Journal of Behavioral Addictions [‘Ten myths about work addiction’] that ‘workaholism’ and ‘work addiction’ are not the same thing, and outlined in a previous blog). Spivak and McKelvie concede that entrepreneurship addiction is a “sister construct” to ‘workaholism’ because of the core elements they have in common. More specifically, in relation to similarities, they assert:

“Workaholism, like entrepreneurship addiction, emphasizes the compulsion to work, working long hours, obsessive thoughts that extend beyond the domain of work, and results in some of the negative outcomes that have been linked to entrepreneurship addiction, including difficulties in social relationships and diminished physical health (Spivack et al., 2014). Some of the conceptualizations of workaholism draw from the literature on psychological disorders. Similarly, we recognize and propose that there may be significant overlap with various psychological conditions among those that develop entrepreneurship addiction, including, but not limited to, obsessive compulsive disorder, bipolar disorder, and ADD/ADHD”.

However, they then do on to describe what they feel are the practical and conceptual distinctions between entrepreneurship addiction and workaholism. More specifically, they argue that:

“(M)ost workaholics are embedded within existing firms and are delegated tasks and resources in line with the organization’s mission, often in a team-based structure. Most workaholics work on these assigned projects with intensity and some will do so with high levels of engagement, as specified in previous literature. But, in reward for their efforts, many employed workaholics may be limited to receiving recognition and performance bonuses. As a team member employed within the structures of an existing organization, the individual’s contribution to organizational outcomes may be obfuscated just as the reciprocal impact of organizational performance (whether negative or positive) on the individual may be buffered (i.e., there is little chance an employee will lose their home if the business doesn’t perform well). In contrast, entrepreneurs, by definition, are proactive creators of their work context. They are responsible for a myriad of decisions and actions both within and outside of the scope of their initial expertise, and are challenged to situate their work within a dynamic business environment. Entrepreneurs are more clearly linked with their work, as they are responsible for acquiring the resources and implementing them in unique business strategies to create a new entity”.

I would argue that many of the things listed here are not unique to entrepreneurs as I could argue that in my own job as a researcher that I also have many of the benefits outlined above (because within flexible parameters I have a job that I can do what I want, when I want, how I want, and with who I want – there are so many possible rewards in the job I do that it isn’t that far removed from entrepreneurial activity – in fact some of my job now actually includes entrepreneurial activity). As Spivak and McKelvie then go on to say:

“As a result of the intense qualities of the entrepreneurial experience, there are also more intense potential outcomes, whether rewards or punishments in financial, social, and psychological domains. For example, potential rewards for entrepreneurs extend far beyond supervisor recognition and pay bonuses, into the realm of public awareness of accomplishments (or failures), media heralding, and life-changing financial gains or losses. Entrepreneurship addiction thereby moves beyond workaholism into similarities with gambling because of the intensity of the experience and personal risk tied to outcomes”.

I’m not sure I would agree with the gambling analogy, but I agree with the broad thrust of what is being argued (but would still say that entrepreneurship addiction is a sub-type of work addiction). I ought to add that there has also been discussion about the risk of overabundance of unsubstantiated addictive disorders. For instance, in a 2015 paper in the Journal of Behavioral Addiction, Joel Billieux and his colleagues described a hypothetical case of someone they deem fitting into the criteria of the concept of “research addiction” (maybe they had someone like myself in mind?), invented for the purpose of the argument. However, it is worthwhile noting that if their hypothetical example of ‘research addiction’ already fits well into the persisting compulsive over-involvement in job/study to the exclusion of other spheres of life, and if it leads to serious harm (and conflict symptoms suggest that it may) then it could be argued that the person is addicted to work. What we could perhaps agree on, is that for the example of ‘research addiction’ we do not have to invent a new addiction, (just as we do not distinguish between vodka addicts, gin addicts or whisky addicts as there is the overarching construct of alcoholism). Maybe the same argument can be made for entrepreneurship addiction in relation to work addiction.

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

Further reading

Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of norwegian employees. PLoS ONE, 9, e102446. doi:10.1371/journal.pone.0102446

Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265–272. doi:10.1111/sjop.2012.53.issue-3

Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016) The Relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11: e0152978. doi:10.1371/journal.pone.0152978

Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015). Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of Behavioral Addictions, 4, 142–144.

Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R. Eadington & J. Cornelius (Eds.), Gambling Behavior and Problem Gambling (pp. 341-372). Reno, Nevada: University of Nevada Press.

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

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

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

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

Griffiths, M.D., Demetrovics, Z. & Atroszko, P.A. (2018). Ten myths about work addiction. Journal of Behavioral Addictions. Epu ahead of print. doi: 10.1556/2006.7.2018.05

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Paksi, B., Rózsa, S., Kun, B., Arnold, P., Demetrovics, Z. (2009). Addictive behaviors in Hungary: The methodology and sample description of the National Survey on Addiction Problems in Hungary (NSAPH). [in Hungarian] Mentálhigiéné és Pszichoszomatika, 10(4), 273-300.

Quinones, C., & Griffiths, M. D. (2015). Addiction to work: A critical review of the workaholism construct and recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48–59.

Spivack, A., & McKelvie, A. (2017). Entrepreneurship addiction: Shedding light on the manifestation of the ‘dark side’ in work behavior patterns. The Academy of Management Perspectives. https://doi.org/10.5465/amp.2016.0185

Spivack, A. J., McKelvie, A., & Haynie, J. M. (2014). Habitual entrepreneurs: Possible cases of entrepreneurship addiction? Journal of Business Venturing, 29(5), 651-667.

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.

Term warfare: ‘Workaholism’ and work addiction are not the same

Reliable statistics on the prevalence of individuals addicted to work on a country-by-country basis are almost non-existent. Only two countries (Norway and Hungary) has carried out nationally representative studies. Norwegian studies led by Dr. Cecilie Andreassen reported that approximately 7.3%-8.3% of Norwegians are addicted to work using the Bergen Work Addiction Scale. A Hungarian study led by Dr. Zsolt Demetrovics reported that 8.2% of the 18- to 64-year old population working at least 40 hours a week is at risk for work addiction using the Work Addiction Risk Test.

In a comprehensive literature review that I co-authored using US data, provided a tentative estimation of the prevalence of work addiction among Americans at 10%. Some estimates are as high as 15%-25% among employed individuals although some of these estimates appear to relate to excessive and committed working rather than a genuine addictive behaviour Others claim that the rates of work addiction are high amongst professionals (e.g., lawyers, medics, scientists). Such individuals may work very long hours, expend high effort in their job, delegate rarely, and may not necessarily be more productive. It also appears that those genuinely addicted to work appear to have a compulsive drive to gain approval and success but can result in impaired judgment, poor health, burnout, and breakdowns as opposed to what might be described ‘enthusiastic workaholism’ where few problems are associated with the behaviour.

Illustration with word cloud on the subject of workaholism

Last month, I and two of my colleagues published a paper in the Journal of Behavioral Addictions examining various myths concerning work addiction. One of the myths we explored was that ‘work addiction is similar to other behavioural addictions’. While work addiction does indeed have many similarities to other behavioural addictions (e.g., gambling, gaming, shopping, sex, etc.), it fundamentally differs from them in a critical way because it is the only behaviour that individuals are typically required to do eight hours a day and is an activity that individuals receive gratification from the local environment and/or society more generally for engaging in the activity. There may also be some benefits from normal [and excessive] work (e.g., financial security through earning a good salary, financial bonuses based on productivity, international travel, free or reduced medical insurance, company car, etc.). Unlike other behavioural and substance addictions where one of the key criteria is typically a negative impact on occupational duties, work addicts cannot negatively impact on the activity they are already engaged in (except in the sense that their addiction to work may impacts on work productivity or work quality due to resulting psychological and/or physical illness).

In some respects, work addiction is similar to exercise addiction in that it is an activity that should be a part of people’s lives and often has some benefits even when engaged in excessively. Such activities have been described by Ian Brown as ‘mixed blessings’ addictions. For instance, in the case of exercise addiction, problematic exercise that interferes with both job and relationships can still have some positive consequences (such as being physically fit). However, it should be emphasized that such positive consequences are typically short lasting, and in the long run, addiction will take its toll on health (even exercise in excess is physiologically unhealthy in the long run in terms of immune function, cardiovascular health, bone health, and mental health). Furthermore, some research suggests that work and exercise addiction have also similar personality correlates different from other addictions, namely high conscientiousness. This might contribute to the fact that work addiction is so perplexing because this personality trait is consistently linked to better health.

Another myth we explored was ‘work addiction and workaholism are the same thing’. The issue of whether ‘workaholism’ and ‘work addiction’ are the same entity depends on how these constructs are defined. For instance, I have argued that any behaviour that fulfils six core components (i.e., salience, conflict, mood modification, tolerance, withdrawal symptoms, and relapse) should be operationalized as an addiction. These six components have also been the basis of many psychometric instruments for assessing potential addictions including work addiction (such as the Bergen Work Addiction Scale that I co-developed and was published in a 2012 issue of the Journal of Scandinavian Psychology). The empirical research carried out by myself and others over the last five years concerning ‘work addiction’ is theoretically rooted in the core addiction literature whereas ‘workaholism’ncludes a wider range of theoretical underpinnings and in some research is a construct seen as something positive rather than negative. Arguably, in popular press and in common everyday language ‘workaholism’ is often used as a positive notiono describe very engaged workers, which adds significantly to the confusion about the two terms.

‘Workaholism’ is arguably a generic term that throughout the literature (as well as by lay people and the popular press) appears to equate to excessive working irrespective of whether the consequences are advantageous or disadvantageous. There is clearly lack of precise dictionary definitions of ‘work addiction’ and ‘workaholism’, and there is no reason to assume they could not be used as synonyms. However, the common use of the term ‘workaholism’ to denote anything related to high involvement in work may suggest that for practical reasons in the professional literature on work addiction, understood within addiction framework, it would be advisable to limit usage of this term. While, it is almost impossible to control natural usage of terms, preference for ‘work addiction’ in addiction literature would be a way to emphasize the addiction framework in which the phenomenon is being conceptualized. In short, ‘work addiction’ is a psychological construct while ‘workaholism’ is arguably a more generic term.

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

Further reading

Andreassen, C. S., Griffiths, M. D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of norwegian employees. PLoS ONE, 9, e102446. doi:10.1371/journal.pone.0102446

Andreassen, C. S., Griffiths, M. D., Hetland, J., & Pallesen, S. (2012). Development of a work addiction scale. Scandinavian Journal of Psychology, 53, 265–272. doi:10.1111/sjop.2012.53.issue-3

Andreassen, C. S., Griffiths, M. D., Sinha, R., Hetland, J., & Pallesen, S. (2016) The Relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11: e0152978. doi:10.1371/journal.pone.0152978

Brown, R. I. F. (1993). Some contributions of the study of gambling to the study of other addictions. In W.R. Eadington & J. Cornelius (Eds.), Gambling Behavior and Problem Gambling (pp. 341-372). Reno, Nevada: University of Nevada Press.

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

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

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

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

Griffiths, M.D., Demetrovics, Z. & Atroszko, P.A. (2018). Ten myths about work addiction. Journal of Behavioral Addictions. Epu ahead of print. doi: 10.1556/2006.7.2018.05

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Paksi, B., Rózsa, S., Kun, B., Arnold, P., Demetrovics, Z. (2009). Addictive behaviors in Hungary: The methodology and sample description of the National Survey on Addiction Problems in Hungary (NSAPH). [in Hungarian] Mentálhigiéné és Pszichoszomatika, 10(4), 273-300.

Quinones, C., & Griffiths, M. D. (2015). Addiction to work: A critical review of the workaholism construct and recommendations for assessment. Journal of Psychosocial Nursing and Mental Health Services, 10, 48–59.

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.

Surprise, surprise: A brief overview of our recent papers on strange addictions and behaviours

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

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

• Background: Muscle dysmorphia (MD) describes a condition characterised by a misconstrued body image in which individuals who interpret their body size as both small or weak even though they may look normal or highly muscular. MD has been conceptualized as a type of body dysmorphic disorder, an eating disorder, and obsessive–compulsive disorder symptomatology. Method and aim: Through a review of the most salient literature on MD, this paper proposes an alternative classification of MD – the ‘Addiction to Body Image’ (ABI) model – using Griffiths (2005) addiction components model as the framework in which to define MD as an addiction. Results: It is argued the addictive activity in MD is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and the use or purchase of physical exercise accessories). In the ABI model, the perception of the positive effects on the self-body image is accounted for as a critical aspect of the MD condition (rather than addiction to exercise or certain types of eating disorder). Conclusions: Based on empirical evidence to date, it is proposed that MD could be re-classified as an addiction due to the individual continuing to engage in maintenance behaviours that may cause long-term harm.

Griffiths, M.D., Foster, A.C. & Shorter, G.W. (2015). Muscle dysmorphia as an addiction: A response to Nieuwoudt (2015) and Grant (2015). Journal of Behavioral Addictions, 4, 11-13.

• Background: Following the publication of our paper ‘Muscle Dysmorphia: Could it be classified as an addiction to body image?’ in the Journal of Behavioral Addictions, two commentaries by Jon Grant and Johanna Nieuwoudt were published in response to our paper. Method: Using the ‘addiction components model’, our main contention is that muscle dysmorphia (MD) actually comprises a number of different actions and behaviors and that the actual addictive activity is the maintaining of body image via a number of different activities such as bodybuilding, exercise, eating certain foods, taking specific drugs (e.g., anabolic steroids), shopping for certain foods, food supplements, and purchase or use of physical exercise accessories. This paper briefly responds to these two commentaries. Results: While our hypothesized specifics relating to each addiction component sometimes lack empirical support (as noted explicitly by both Nieuwoudt and Grant), we still believe that our main thesis (that almost all the thoughts and behaviors of those with MD revolve around the maintenance of body image) is something that could be empirically tested in future research by those who already work in the area. Conclusions: We hope that the ‘Addiction to Body Image’ model we proposed provides a new framework for carrying out work in both empirical and clinical settings. The idea that MD could potentially be classed as an addiction cannot be negated on theoretical grounds as many people in the addiction field are turning their attention to research in new areas of behavioral addiction.

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

• Dancing is a popular form of physical exercise and studies have show that dancing can decrease anxiety, increase self-esteem, and improve psychological wellbeing. The aim of the current study was to explore the motivational basis of recreational social dancing and develop a new psychometric instrument to assess dancing motivation. The sample comprised 447 salsa and/or ballroom dancers (68% female; mean age 32.8 years) who completed an online survey. Eight motivational factors were identified via exploratory factor analysis and comprise a new Dance Motivation Inventory: Fitness, Mood Enhancement, Intimacy, Socialising, Trance, Mastery, Self-confidence and Escapism. Mood Enhancement was the strongest motivational factor for both males and females, although motives differed according to gender. Dancing intensity was predicted by three motivational factors: Mood Enhancement, Socialising, and Escapism. The eight dimensions identified cover possible motives for social recreational dancing, and the DMI proved to be a suitable measurement tool to assess these motives. The explored motives such as Mood Enhancement, Socialising and Escapism appear to be similar to those identified in other forms of behaviour such as drinking alcohol, exercise, gambling, and gaming.

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

• Although recreational dancing is associated with increased physical and psychological well-being, little is known about the harmful effects of excessive dancing. The aim of the present study was to explore the psychopathological factors associated with dance addiction. The sample comprised 447 salsa and ballroom dancers (68% female, mean age: 32.8 years) who danced recreationally at least once a week. The Exercise Addiction Inventory (Terry, Szabo, & Griffiths, 2004) was adapted for dance (Dance Addiction Inventory, DAI). Motivation, general mental health (BSI-GSI, and Mental Health Continuum), borderline personality disorder, eating disorder symptoms, and dance motives were also assessed. Five latent classes were explored based on addiction symptoms with 11% of participants belonging to the most problematic class. DAI was positively associated with psychiatric distress, borderline personality and eating disorder symptoms. Hierarchical linear regression model indicated that Intensity (ß=0.22), borderline (ß=0.08), eating disorder (ß=0.11) symptoms, as well as Escapism (ß=0.47) and Mood Enhancement (ß=0.15) (as motivational factors) together explained 42% of DAI scores. Dance addiction as assessed with the Dance Addiction Inventory is associated with indicators of mild psychopathology and therefore warrants further research.

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

• Objectives: Dacryphilia is a non-normative sexual interest that involves enjoyment or arousal from tears and crying, and to date has never been researched empirically. The present study set out to discover the different interests within dacryphilia and explore the range of dacryphilic experience. Methods: A set of online interviews were carried out with individuals with dacryphilic preferences and interests (six females and two males) from four countries. The data were analyzed for semantic and latent themes using thematic analysis. Results: The respondents’ statements focused attention on three distinct areas that may be relevant to the experience of dacryphilia: (i) compassion; (ii) dominance/submission; and (iii) curled-lips. The data provided detailed descriptions of features within all three interests, which are discussed in relation to previous quantitative and qualitative research within emotional crying and tears, and the general area of non-normative sexual interests. Conclusions: The study suggests new directions for potential research both within dacryphilia and with regard to other non-normative sexual interests.

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

• Aims: Recent research has suggested that for some individuals, educational studying may become compulsive and excessive and lead to ‘study addiction’. The present study conceptualized and assessed study addiction within the framework of workaholism, defining it as compulsive over-involvement in studying that interferes with functioning in other domains and that is detrimental for individuals and/or their environment. Methods: The Bergen Study Addiction Scale (BStAS) was tested — reflecting seven core addiction symptoms (salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems) — related to studying. The scale was administered via a cross-sectional survey distributed to Norwegian (n = 218) and Polish (n = 993) students with additional questions concerning demographic variables, study-related variables, health, and personality. Results: A one-factor solution had acceptable fit with the data in both samples and the scale demonstrated good reliability. Scores on BStAS converged with scores on learning engagement. Study addiction (BStAS) was significantly related to specific aspects of studying (longer learning time, lower academic performance), personality traits (higher neuroticism and conscientiousness, lower extroversion), and negative health-related factors (impaired general health, decreased quality of life and sleep quality, higher perceived stress). Conclusions: It is concluded that BStAS has good psychometric properties, making it a promising tool in the assessment of study addiction. Study addiction is related in predictable ways to personality and health variables, as predicted from contemporary workaholism theory and research.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, 5, 357–362.

• Background and aims: ‘Study addiction’ has recently been conceptualized as a behavioral addiction and defined within the framework of work addiction.  Using a newly developed measure to assess this construct, the Bergen Study Addiction Scale (BStAS), the present study examined the one-year stability of study addiction and factors related to changes in this construct over time, and is the first longitudinal investigation of study addiction thus far. Methods: The BStAS and the Ten Item Personality Inventory (TIPI) were administered online together with questions concerning demographics and study-related variables in two waves. In Wave 1, a total of 2,559 students in Norway and 2,177 students in Poland participated. A year later, in Wave 2, 1,133 Norwegians and 794 Polish who were still students completed the survey. Results: The test-retest reliability coefficients for the BStAS revealed that the scores were relatively stable over time. In Norway scores on the BStAS were higher in Wave 2 than in Wave 1, while in Poland the reverse pattern was observed. Learning time outside classes at Wave 1 was positively related to escalation of study addiction symptoms over time in both samples. Being female and scoring higher on neuroticism were related to an increase in study addiction in the Norwegian sample only. Conclusion: Study addiction appears to be temporally stable, and the amount of learning time spent outside classes predicts changes in study addiction one year later.

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

Further reading

Greenhill, R. & Griffiths, M.D. (2014). The use of online asynchronous interviews in the study of paraphilias. SAGE Research Methods Cases. Located at: http://dx.doi.org/10.4135/978144627305013508526

Greenhill, R. & Griffiths, M.D. (2016). Sexual interest as performance, intellect and pathological dilemma: A critical discursive case study of dacryphilia. Psychology and Sexuality, 7, 265-278.

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

Griffiths, M.D. (1999). Dying for it: Autoerotic deaths. Bizarre, 24, 62-65.

Griffiths, M.D. (2001). Stumped! Amputee fetishes. Bizarre, 44, 70-74.

Griffiths, M.D. (2001). Heaven can wait: The psychology of near death experiences. Bizarre, December, 63-66.

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

Griffiths, M.D. (2013). Bizarre sex. New Turn Magazine, 3, 49-51.

Griffiths, M.D. (2013). Eproctophilia in a young adult male: A case study. Archives of Sexual Behavior, 42, 1383-1386.

Specific limb: A brief look at ‘restless legs syndrome’

Those that know me well often comment that I have a general inability to sit still and that I am a ‘fidget’. (This is not necessarily a bad thing and in fact there are some positives to fidgeting that I outlined in a previous blog on bad behaviours that are sometimes good for you). There is certainly some truth to the observation that I fidget but sometimes the fidgeting is out of my control. Every few weeks my right lower leg appears to take on a life of its own and I will get strange (uncomfortable) sensations (such as tingling, itching, and aching, and occasionally cramp-like feelings) that force me to move my right leg and foot around. It only happens when I am in a resting and relaxing state and usually lasts about 30 minutes (but can occasionally last much longer). On occasions it disrupts my work and sleep but I find that just getting up and moving around is sometimes enough to alleviate the uncomfortable feelings.

A few years ago I Googled my ‘symptoms’ and was surprised to find that I am not the only person who appears to experience such effects and that there is a whole medical literature on what has been termed ‘restless legs syndrome’ although in my case it would be in a singular rather than plural form). I’ve had the condition for about 15 years now and it may be related to some of the medication I take for an unrelated chronic degenerative health condition that I have. According to the Wikipedia entry on restless legs syndrome (RLS):

“The first known medical description of RLS was by Sir Thomas Willis in 1672. Willis emphasized the sleep disruption and limb movements experienced by people with RLS…The term ‘fidgets in the legs’ has also been used as early as the early nineteenth century. Subsequently, other descriptions of RLS were published, including those by Francois Boissier de Sauvages (1763), Magnus Huss (1849), Theodur Wittmaack (1861), George Miller Beard (1880), Georges Gilles de la Tourette (1898), Hermann Oppenheim (1923) and Frederick Gerard Allison (1943). However, it was not until almost three centuries after Willis, in 1945, that Karl-Axel Ekbom (1907–1977) provided a detailed and comprehensive report of this condition in his doctoral thesis, Restless legs: clinical study of hitherto overlooked disease. Ekbom coined the term “restless legs” and continued work on this disorder throughout his career. He described the essential diagnostic symptoms, differential diagnosis from other conditions, prevalence, relation to anemia, and common occurrence during pregnancy. Ekbom’s work was largely ignored until it was rediscovered by Arthur S. Walters and Wayne A. Hening in the 1980s. Subsequent landmark publications include 1995 and 2003 papers, which revised and updated the diagnostic criteria”.

As well as being referred to as RLS, it is sometimes referred to as Willis-Ekbom Disease or Willis-Ekbom Syndrome. Since being ‘rediscovered’ in the 1980s, there have been a lot of scientific papers published on the phenomenon although many of these are medical case studies (I don’t think my own experiences are extreme enough or strong enough to appear in any medical textbook. The Wikipedia entry on RLS provides a good summary of what is known medically and empirically:

“Restless legs syndrome (RLS) is a disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat with moving them. Occasionally the arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers. There are two main types. One is early onset RLS which starts before age 45 [years], runs in families and worsens over time. The other is late onset RLS which begins after age 45 [years], starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes… Females are more commonly affected than males and it becomes more common with age…Some doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it. Others believe it is an under-recognized and undertreated disorder…An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain”.

According to a review by Dr. Richard Allen and Dr. Christopher Earley in the Journal of Clinical Neurophysiology, RLS affects 2.5-15% of the US population. In another review on sleep disorder in the journal American Family Physician, Dr. Kannan Ramar and Dr. Eric Olson reported that RLS is typically characterized by four essential features: These are:

“(1) the intense urge to move the legs, usually accompanied or caused by uncomfortable sensations (e.g., “creepy crawly,” aching) in the legs; (2) symptoms that begin or worsen during periods of rest or inactivity; (3) symptoms that are partially or totally relieved by movements such as walking or stretching; and (4) symptoms that are worse or only occur in the evening or at night”.

Various online articles and papers report a variety of potential treatments based on the notion that RLS might be caused by a dopamine imbalance in the body. Some medics advise a regular sleep routine (such as that advised for those with insomnia), and cutting out the drinking of alcohol and the smoking of cigarettes. Pharmacological treatments include the use of drugs that are also used in the treatment of Parkinson’s disease such as L-DOPA and pramipexole, and the use of magnesium sulphate therapy (as reported in a 2006 paper in the Journal of Clinical Sleep Medicine – magnesium is known to be a natural muscle relaxant). In a 2011 issue of the journal Sleep Medicine, In an online article about RLS, Dr Michael Platt, author of the 2014 book Adrenalin Dominance, claims that RLS sufferers can be treated using a progesterone cream:

“Excess adrenalin during the night can cause restless leg syndrome. People often have associated symptoms also resulting from elevated adrenalin, such as teeth grinding, the need to urinate, and tossing and turning, and they often awaken in the morning with low back pain. Characteristically, RLS patients have an excess of adrenaline, may toss and turn all night, be quick to anger, might be workaholics, will usually have fibromyalgia (aches and pains – low back, side of the hips, and grind their teeth), they might drink too much, and will be hypoglycemic (sleepy between 3-4 p.m. or when in a car), and so on. There is an associated over-production of insulin and an under-production of progesterone…[By using a progesterone cream] I have had 100% success with eliminating RLS by getting hormones into balance, often within the first week. Patients feel more relaxed, they can sleep at night, rage disappears, and they can focus more easily”.

Dr. Luis Marin and his colleagues reported a different treatment for RLS altogether. They reported the case of a 41-year-old male RLS sufferer who after being on medication for RLS discovered his own solution – having sex. Following sex, the man reported that all RLS symptoms would disappear. Marin and colleagues speculated that the release of dopamine following orgasm might alleviate RLS symptoms. This appears to be a reasonable speculation given the findings of research published in the Journal of Neuroscience by Dr. Gert Holstege and his colleagues who examined brain activation at the point of ejaculation. In their paper they reported the similarity between ejaculation and using heroin in terms of brain activation:

“We used positron emission tomography to measure increases in regional cerebral blood flow during ejaculation compared with sexual stimulation in heterosexual male volunteers. Manual penile stimulation was performed by the volunteer’s female partner. Primary activation was found in the mesodiencephalic transition zone, including the ventral tegmental area, which is involved in a wide variety of rewarding behaviors. Parallels are drawn between ejaculation and heroin rush”.

It could well be that the increase in dopamine following ejaculation acts in a similar way to the medications that are given to RLS sufferers. Of all the treatments for RLS that I have read about, I think I know which one I would prefer!

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

Further reading

Allen, R.P., & Earley, C.J. (2001). Restless legs syndrome: A review of clinical and pathophysiologic features. Journal of Clinical Neurophysiology, 18(2), 128-147.

Bartell S1, Zallek S. Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy. Journal of Clinical Sleep Medicine, 15, 187-188.

Chaudhuri, K.R., Appiah-Kubi, L.S., & Trenkwalder, C. (2001). Restless legs syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 71(2), 143-146.

Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of Internal Medicine, 266(5), 419-431.

Holstege, G., Georgiadis, J. R., Paans, A. M., Meiners, L. C., van der Graaf, F. H., & Reinders, A. S. (2003). Brain activation during human male ejaculation. Journal of Neuroscience, 23(27), 9185-9193

Leschziner, G., & Gringras, P. (2012). Restless legs syndrome. British Medical Journal, 344, e3056.

Marin, L.F., Felicio, A.C., & Prado, G.F. (2011). Sexual intercourse and masturbation: Potential relief factors for restless legs syndrome? Sleep Medicine, 12(4), 422.

Ondo, W. G. (2009). Restless legs syndrome. Neurologic Clinics, 27(3), 779-799.

Ramar, K; Olson, EJ (Aug 15, 2013). Management of common sleep disorders. American Family Physician, 88, 231–238.

Satija, P., & Ondo, W. G. (2008). Restless legs syndrome. CNS Drugs, 22(6), 497-518.

Meditation as self-medication: Can mindfulness be addictive?

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

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

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

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

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

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

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

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

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

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

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

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

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

Further Reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Career to the ground: A brief overview of our recent papers on workaholism

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

Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

• Research into excessive work has gained increasing attention over the last 20 years. Terms such as “workaholism,””work addiction” and “excessive work” have been used interchangeably. Given the increase in empirical research, this study presents the development of the Bergen Work Addiction Scale (BWAS), a new psychometrically validated scale for the assessment of work addiction. A pool of 14 items, with two reflecting each of seven core elements of addiction (i.e., salience, mood modification, tolerance, withdrawal, conflict, relapse, and problems) was initially constructed. The items were then administered to two samples, one recruited by a web survey following a television broadcast about workaholism (n=11,769) and one comprising participants in the second wave of a longitudinal internet-based survey about working life (n=368). The items with the highest corrected item-total correlation from within each of the seven addiction elements were retained in the final scale. The assumed one-factor solution of the refined seven-item scale was acceptable (root mean square error of approximation=0.077, Comparative Fit Index=0.96, Tucker-Lewis Index=0.95) and the internal reliability of the two samples were 0.84 and 0.80, respectively. The scores of the BWAS converged with scores on other workaholism scales, except for a Work Enjoyment subscale. A suggested cut-off for categorization of workaholics showed good discriminative ability in terms of working hours, leadership position, and subjective health complaints. It is concluded that the BWAS has good psychometric properties.

Andreassen, C.S., Griffiths, M.D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of Norwegian employees. PLoS ONE, 9(8): e102446. doi:10.1371/journal.pone.0102446.

• Workaholism has become an increasingly popular area for empirical study. However, most studies examining the prevalence of workaholism have used non-representative samples and measures with poorly defined cut-off scores. To overcome these methodological limitations, a nationally representative survey among employees in Norway (N = 1,124) was conducted. Questions relating to gender, age, marital status, caretaker responsibility for children, percentage of full-time equivalent, and educational level were asked. Workaholism was assessed by the use of a psychometrically validated instrument (i.e., Bergen Work Addiction Scale). Personality was assessed using the Mini-International Personality Item Pool. Results showed that the prevalence of workaholism was 8.3% (95% CI= 6.7–9.9%). An adjusted logistic regression analysis showed that workaholism was negatively related to age and positively related to the personality dimensions agreeableness, neuroticism, and intellect/imagination. Implications for these findings are discussed.

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

• Workaholism was first conceptualized in the early 1970s as a behavioral addiction, featuring compulsive use and interpersonal conflict. The current article briefly examines the empirical and theoretical literature over the past four decades. In relation to conceptualization and measurement, how the concept of workaholism has worsened from using dimensions based on anecdotal evidence, ad-hoc measures with weak theoretical foundation, and poor factorial validity of multidimensional conceptualizations is highlighted. Benefits of building on the addiction literature to conceptualize workaholism are presented (including the only instrument that has used core addiction criteria: the Bergen Work Addiction Scale). Problems estimating accurate prevalence estimates of work addiction are also presented. Individual and sociocultural risk factors, and the negative consequences of workaholism from the addiction perspective (e.g., depression, burnout, poor health, life dissatisfaction, family/relationship problems) are discussed. The current article summarizes how current research can be used to evaluate workaholism by psychiatric–mental health nurses in clinical practice, including primary care and mental health settings.

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

• Introduction: Research on the consequences of sickness presenteeism, or the phenomenon of attending work whilst ill, has focused predominantly on identifying its economic, health, and absenteeism outcomes, in the process neglecting important attitudinal-motivational outcomes. Purpose: A mediation model of sickness presenteeism as a determinant of job satisfaction via affective-motivational states (specifically engagement with work and addiction to work) is proposed. This model adds to the current literature, by focussing on (i) job satisfaction as an outcome of presenteeism, and (ii) the psychological processes associated with this. It posits sickness presenteeism as psychological absence and work engagement and work addiction as motivational states that originate in that. Methods: An online survey on sickness presenteeism, work engagement, work addiction, and job satisfaction was completed by 158 office workers. Results: The results of bootstrapped mediation analysis with observable variables supported the model. Sickness presenteeism was negatively associated with job satisfaction. This relationship was fully mediated by both engagement with work and addiction to work, explaining a total of 48.07% of the variance in job satisfaction. Despite the small sample, the data provide preliminary support for the model. Conclusions: Given that there is currently no available research on the attitudinal consequences of sickness presenteeism, these findings offer promise for advancing theorising in this area.

Quinones, C., Griffiths, M.D. & Kakabadse, N. (2016). Compulsive Internet use and workaholism: An exploratory two-wave longitudinal study. Computers in Human Behavior, 60, 492-499.

• Workaholism refers to the uncontrollable need to work and comprises working compulsively (WC) and working excessively (WE). Compulsive Internet Use (CIU), involves a similar behavioural pattern although in specific relation to Internet use. Since many occupations rely upon use of the Internet, and the lines between home and the workplace have become increasingly blurred, a self-reinforcing pattern of workaholism and CIU could develop from those vulnerable to one or the other. The present study explored the relationship between these compulsive behaviours utilizing a two-wave longitudinal study over six months. A total of 244 participants who used the Internet as part of their occupational role and were in full-time employment completed the online survey at each wave. This survey contained previously validated measures of each variable. Data were analysed using cross-lagged analysis. Results indicated that Internet usage and CIU were reciprocally related, supporting the existence of tolerance in CIU. It was also found that CIU at Time 1 predicted WC at Time 2 and that WE was unrelated to CIU. It is concluded that a masking mechanism appears a sensible explanation for the findings. Although further studies are needed, these findings encourage a more holistic evaluation and treatment of compulsive behaviours.

Orosz, G., Dombi, E., Andreassen, C.S., Griffiths, M.D. & Demetrovics, Z. (2016). Analyzing models of work addiction: Single factor and bi-factor models of the Bergen Work Addiction Scale. International Journal of Mental Health and Addiction, in press.

• Work addiction (‘workaholism’) has become an increasingly studied topic in the behavioral addictions literature and had led to the development of a number of instruments to assess it. One such instrument is the Bergen Work Addiction Scale (BWAS). However, the BWAS has never been investigated in Eastern-European countries. The goal of the present study was to examine the factor structure, the reliability and cut-off scores of the BWAS in a comprehensive Hungarian sample. This study is a direct extension of the original validation of BWAS by providing results on the basis of representative data and the development of appropriate cut-off scores. The study utilized an online questionnaire with a Hungarian representative sample including 500 respondents (F = 251; Mage = 35.05 years) who completed the BWAS. A series of confirmatory factor analyses were carried out leading to a short, 7-item first-order factor structure and a longer 14-item seven-factor nested structure. Despite the good validity of the longer version, its reliability was not as high as it could have been. One-fifth (20.6 %) of the Hungarians who used the internet at least weekly were categorized as work addicts using the BWAS. It is recommended that researchers use the original seven items from the Norwegian scale in order to facilitate and stimulate cross-national research on addiction to work.

Andreassen, C.S., Griffiths, M.D., Sinha, R., Hetland, J. & Pallesen, S. (2016). The relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11(5): e0152978. doi:10.1371/journal. pone.0152978.

• Despite the many number of workaholism studies, large-scale studies have been lacking. The present study utilized an open web-based cross-sectional survey assessing symptoms of psychiatric disorders and workaholism among 16,426 workers (M_age=37.3 years, SD₌11.4, range=16-75 years). Participants were administered the Adult ADHD Self-Report Scale, the Obsession-Compulsive Inventory-Revised, the Hospital Anxiety and Depression Scale, and the Bergen Work Addiction Scale, along with additional questions examining demographic and work-related variables. Analyses of variance revealed significant workaholism group differences in terms of age, marital status, education, professional position, work sector, occupation, and annual income. No gender differences were found, except in a logistic regression analysis, indicating that women had a greater risk than men of being categorized as workaholics. Correlations between all psychiatric symptoms and workaholism were significant and positively correlated. Workaholism comprised the dependent variable in a four-step linear multiple hierarchical regression analysis as well as in a logistic regression analysis. In the linear regression analysis demographics (age, gender, and marital status) explained 0.8% of the variance in workaholism. The mental health variables (ADHD, OCD, anxiety, and depression) explained between 1.9% and 11.9% of the variance. In an adjusted logistic regression analysis, all psychiatric symptoms were positively associated with workaholism. Although most effect sizes were relatively small, the study’s findings expand our understanding of possible mental health predictors of workaholism, and sheds new light on the reality of adult ADHD in work life. The study’s implications, strengths, and shortcomings are also discussed.

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

Further reading

Griffiths, M.D. (2005). Workaholism is still a useful construct Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Karanika-Murray, M., Duncan, N., Pontes, H. & Griffiths, M.D. (2015). Organizational identification, work engagement, and job satisfaction. Journal of Managerial Psychology, 30, 1019-1033.

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

Occupational hazards: The relationship between workaholism, ADHD, and psychiatric disorders

A few weeks ago, my colleagues and I received a lot of media coverage around the world for our latest study on workaholism that was published in the journal PLoS ONE. The study involved researchers from the University of Bergen (Norway) and Yale University USA) and is probably the largest ever study done on the topic as it included 16,426 working Norwegian adults. Our study got a lot of press attention because we examined the associations between workaholism and a number of different psychiatric disorders.

We found that workaholics scored higher on all the psychiatric symptoms than non-workaholics. For instance we found that among those we classed as workaholics (using the Bergen Work Addiction Scale that we published in the Scandinavian Journal of Psychology four years ago and which I talked about in a previous blog), we found that:

• 32.7% met ADHD (attention-deficit/hyperactivity disorder) criteria (12.7 per cent among non-workaholics).
• 25.6% met OCD (obsessive-compulsive disorder) criteria (8.7 per cent among non-workaholics).
• 33.8% met anxiety criteria (11.9 per cent among non-workaholics).
• 8.9% met depression criteria (2.6 per cent among non-workaholics).

These were all statistically significant differences between workaholics and non-workaholics.

I think a lot of people wondered why we looked at the relationship between workaholism and ADHD to begin with. Firstly, research has consistently demonstrated that Attention-Deficit/Hyperactivity Disorder (ADHD) increases the risk of various chemical and non-chemical addictions. ADHD is prevalent in 2.5–5% of the adult population, and is typically manifested by inattentiveness and lack of focus, and/or impulsivity, and excessive physical activity. Individuals with ADHD may often stop working due to their disorder, and may have trouble in getting work health insurance as they are regarded as a risk group. For this reason, we thought that individuals with ADHD may compensate for this by over-working to meet the expectations required to hold down a job. Although this is a contentious issue, there are a number of reasons why ADHD may be relevant to workaholism.

Firstly, we argued that the inattentive nature of individuals with ADHD causes them to spend time beyond the typical working day (i.e., evenings and weekends) to accomplish what is done by their fellow employees within normal working hours (i.e., the compensation hypothesis). In addition, as they may have a hard time concentrating while at work due to environmental noise and distractions (especially office work in open landscape environments), they might find it easier to work after co-workers have left their working environment or work from home. Their attentive shortcomings may also cause them to overly check for errors on the tasks given, since they often experience careless mistakes due to their inattentiveness. This may cause a cycle of procrastination, work binges, exhaustion, and – in some cases – a fear of imperfection. Although ADHD is associated with lack of focus, such individuals often have the ability to hyper-focus once they find something interesting–often being unable to detach themselves from the task.

Secondly, we argued that the impulsive nature of individuals with ADHD causes them to say ‘yes’ and taking on many tasks without them thinking ahead, and taking on more work than they can realistically handle–eventually leading to workaholic levels of activity. Thirdly, we also argued that the hyperactive nature of individuals with ADHD and the need to be constantly active without being able to relax, causes such individuals to keep on working in an attempt to alleviate their restless thoughts and behaviors. Consequently, work stress might act as a stimulant, and they may choose active (and often multiple) jobs with high pressure, deadlines and activity (e.g., media, sales, restaurant work) – where they have the opportunity to multitask and constantly shift between tasks (e.g., Type-A personality behavior).

In line with this, Type-A personality has often been associated – and sometimes used inter-changeably – with workaholism in previous research. This line of reasoning also relates to the workaholic type portrayed by Dr. Bryan Robinson (in his 2014 book Chained to the desk: A guidebook for workaholics, their partners and children, and the clinicians who treat them), in which he actually denoted “attention-deficit workaholics” (who tend to start many projects but become bored easily and need to be stimulated at all times). His description of the “relentless” type also corresponds well with ADHD symptoms (i.e., unstoppable in working fast and meeting deadlines, often with many projects going on simultaneously). In other words, these types may utilize work pressure to obtain focus, constantly seeking stimulation, crisis, and excitement – and therefore like risky jobs.

Finally, people with ADHD are often mistaken as being lazy, irresponsible, or unintelligent because of their difficulties with planning, time management, organizing, and decision-making. Feeling misunderstood might cause individuals with ADHD to push themselves to prove these misconceptions as wrong – and resulting in an excessive and/or compulsive working pattern. Such individuals are often intelligent, but may feel forced or motivated to start up their own business (i.e., entrepreneurs), as they find it troubling to adjust to standard work schedules or organizational boundaries. Previous research has highlighted that workaholism is prevalent among entrepreneurs and the self-employed. Often failing in other aspects of life (e.g., family), work for such individuals may become even more important to them (e.g., self- efficacy). This is why we hypothesized that ADHD symptoms will be positively associated with workaholism in our study (and that is what we found).

Obsessive-Compulsive Disorder (OCD) is another underlying psychiatric disorder that increases the likelihood of developing an addiction. Full-blown OCD occurs in approximately 2-3% of children and adults, and is commonly manifested by intrusive thoughts and repetitive behaviors of checking, obsessing, ordering, hoarding, washing, and/or neutralizing. It has been suggested that addictive behaviors might represent a coping and/or escape mechanism of OCD symptoms, or as an OCD-behavior that eventually becomes an addiction in itself. Previous workaholic typologies such as those described by Dr. Kimberly Scotti and her colleagues in the journal Human Relations have incorporated the ‘compulsive-dependent’ and ‘perfectionistic’ workaholic types, and some empirical studies have demonstrated that obsessive-compulsive traits are present among workaholics. The OCD tendency of having the need to arrange things in a certain way (i.e., a strong need for control) and obsessing over details to the point of paralysis – may predispose workers with such traits to develop workaholic working patterns. Again we found in our study that OCD symptoms were positively related to workaholism.

It has also been reported that other psychiatric disorders such as anxiety and depression may also increase the risk of developing an addiction. Approximately 30% of people will suffer from an anxiety disorder in their lifetime, and 20% will have at least one episode of depression. These conditions often occur simultaneously, as most people who are depressed also experience acute anxiety. Consequently, anxiety and/or depression can lead to addiction, and vice versa. A number of studies have previously reported a link between anxiety, depression, and workaholism. Furthermore, we know that workaholism (in some instances) develops as an attempt to reduce uncomfortable feelings of anxiety and depression. Working hard is praised and honored in modern society, and thus serves as a legitimate behavior for individuals to combat or alleviate negative feelings – and to feel better about themselves and raise their self-esteem. This is why we hypothesized that there would be a positive association between anxiety, depression, and workaholism (and that is what we found). In relation to our study’s findings as a whole, the lead author of our study (Dr. Cecilie Andreassen) told the world’s media:

“Taking work to the extreme may be a sign of deeper psychological or emotional issues. Whether this reflects overlapping genetic vulnerabilities, disorders leading to workaholism or, conversely, workaholism causing such disorders, remain uncertain…Physicians should not take for granted that a seemingly successful workaholic does not have ADHD-related or other clinical features. Their considerations affect both the identification and treatment of these disorders”.

Our findings clearly highlighted the importance of further investigating neurobiological differences related to workaholic behaviour. Finally, in line with our previous research published two years ago (also in the PLoS ONE journal) using a nationally representative sample, 7.8% of the participants in our latest study were classed as workaholics compared to 8.3% in our previous study.

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

Further reading

Andreassen, C.S., Griffiths, M.D., Hetland, J., Kravina, L., Jensen, F., & Pallesen, S. (2014). The prevalence of workaholism: A survey study in a nationally representative sample of Norwegian employees. PLoS ONE, 9(8): e102446. doi:10.1371/journal.pone.0102446.

Andreassen, C.S., Griffiths, M.D., Hetland, J. & Pallesen, S. (2012). Development of a Work Addiction Scale. Scandinavian Journal of Psychology, 53, 265-272.

Andreassen, C.S., Griffiths, M.D., Sinha, R., Hetland, J. & Pallesen, S. (2016). The relationships between workaholism and symptoms of psychiatric disorders: A large-scale cross-sectional study. PLoS ONE, 11(5): e0152978. doi:10.1371/journal. pone.0152978.

Griffiths, M.D. (2005). Workaholism is still a useful construct. Addiction Research and Theory, 13, 97-100.

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

Griffiths, M.D. & Karanika-Murray, M. (2012). Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction. Journal of Behavioral Addictions, 1(3), 87-95.

Karanika-Murray, M., Duncan, N., Pontes, H. & Griffiths, M.D. (2015). Organizational identification, work engagement, and job satisfaction. Journal of Managerial Psychology, 30, 1019-1033.

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

Orosz, G., Dombi, E., Andreassen, C.S., Griffiths, M.D. & Demetrovics, Z. (2016). Analyzing models of work addiction: Single factor and bi-factor models of the Bergen Work Addiction Scale. International Journal of Mental Health and Addiction, in press

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

Quinones, C., Griffiths, M.D. & Kakabadse, N. (2016). Compulsive Internet use and workaholism: An exploratory two-wave longitudinal study. Computers in Human Behavior, 60, 492-499.

Robinson, B.E. (2014). Chained to the desk: A guidebook for workaholics, their partners and children, and the clinicians who treat them. New York: New York University Press.

Scotti, K.A., Moore, K.S., & Miceli, M.P. (1997). An exploration of the meaning and consequences of workaholism. Human Relations, 50, 287–314.

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

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.

Tech your time: 12 top tips for a digital detox

Over the last few years there has been increasing use of the term ‘digital detox’. According to the Oxford Dictionary, digital detox is “a period of time during which a person refrains from using electronic devices such as smartphones or computers, regarded as an opportunity to reduce stress or focus on social interaction in the physical world”. I have to admit that I often find it hard to switch off from work (mainly because I love my job). Given that my job relies on technology, by implication it also means I find it hard to switch off from technology. Today’s blog is as much for me as anyone reading this and provides some tips on how to cut down on technology use, even if it’s just for the weekend or a holiday. I have compiled these tips from many different online articles as well as some of my own personal strategies. 

Digitally detox in increments: For some people, going a few minutes without checking their smartphone or emails is difficult. For many, the urge is reflexive and habitual. If you are one of those people, then ‘baby steps’ are needed. Such individuals need to learn to digitally detox in small increments (i.e., go on a ‘digital diet’). Start by proving to yourself that you can go 15 minutes without technology. Over time, increase the length of time without checking (say) Twitter, Facebook and emails (e.g., 30 minutes, 60 minutes, a couple of hours) until you get into a daily habit of being able to spend a few hours without the need to be online. Another simple trick is to only keep mobile devices partially topped up. This means users have to be sparing when checking their mobile devices.

Set aside daily periods of self-imposed non-screen time: One of the secrets to cutting down technology use to acceptable levels is to keep aside certain times of the day technology-free (meal times and bedtime are a good starting place – in fact, these rooms should be made technology-free). For instance, I rarely look at any emails between 6pm and 8pm as this is reserved for family time (e.g., cooking and eating dinner with the family). Another strategy to try is having a technology-free day at the weekends (e.g., not accessing the internet at all for 24 hours). However, watching television or using an e-reader is fine. Another simple strategy is to have technology-free meal times (at both home and work). Don’t bring your smartphone or tablet to the table.

Only respond to emails and texts at specific times of the day: Only a few individuals are ‘on call’ and have to assume that the message they receive will be an emergency. Looking at emails (say) just three times a day (9am, 1pm, 4pm) will save lots of time in the long run. Turning off email and social media, disabling push notifications, or simply turning the volume setting to silent on electronic devices will also reduce the urge to constantly check mobile devices.

Don’t use your smartphone or tablet as an alarm clock: By using a standard alarm clock to wake you in the morning, you will avoid the temptation to look at emails and texts just as you are about to go to sleep or just wake up (or in the middle of the night if you are a workaholic!).

Engage in out-of-work activities where it is impossible (or frowned upon) to use technology: Nowadays, leisure activities such as going to the pub, having a meal, or going to the cinema, don’t stop people using wireless technology. By engaging in digitally incompatible activities where it is impossible to access technology simultaneously (e.g., jogging, swimming, meditation, outdoor walks in wi-fi free areas) or go to places where technology is frowned upon (e.g., places of worship, yoga classes, etc.) and individual will automatically decrease the amount of screen time. In social situations, you can turn people’s need to check their phones into a game. For instance, in the pub, you could have a game where the first one to check their phone has to buy a round of drinks for everyone else.

Tell your work colleagues and friends you are going on a digital detox: Checking emails and texts can become an almost compulsive behaviour because of what psychologists have termed ‘FOMO’ (fear of missing out) that refers to the anxiety that an interesting or exciting event may be happening elsewhere online. By telling everyone you know that you will not be online for a few hours, they will be less likely to contact you in the first place and you will be less likely check for online messages in the first place. Alternatively, Put your ‘out-of-office’ notification on for a few hours and do something more productive with your time.

Reduce your contact lists: One way to spend less time online is to reduce the number of friends on social networking sites, stop following blogs (but not mine, of course!), delete unused apps, and unsubscribe from online groups that have few benefits. Also, delete game apps that can be time-consuming (e.g., Angry Birds, Candy Crush Saga, etc.).

Get a wristwatch: One of the most common reasons for looking at a smartphone or a tablet is to check the time. If checking the time also leads to individuals noticing they have a text, email or tweet, they will end up reading what has been sent. By using an old fashioned wristwatch (as opposed to new smart watches like the Apple Watch), the urge to reply to messages will decrease.

Think about the benefits of not constantly being online: If you are the kind of person that responds to emails, texts and tweets as they come in, you will write longer responses than if you look at them all in a block. The bottom line is that you can save loads of time to spend on other things if you didn’t spend so long constantly reacting to what is going on in the online world.

Enjoy the silence: Too many people fail to appreciate being in the moment and allowing themselves to resist the urge to log onto their laptops, mobiles and tablets. It is at these times that some people might interpret as boredom that we can contemplate and be mindful. This could be made more formal by introducing meditation into a daily routine. There are also many places that run whole weekends and short breaks where technology is forbidden and much of the time can be spent in quiet contemplation. 

Fill the void: To undergo digital detox for any length of time, an individual has to replace the activity with something that is as equally rewarding (whether it is physically, psychologically or spiritually). When I’m on holiday, I catch up on all the novels that I’ve been meaning to read. In shorter spaces of time (such as sitting in boring meetings) I doodle, write ‘to do’ lists, generate ideas to write about, or simply do nothing (and be mindful, aware of the present moment). In short, I try to productive (or unproductive) without having to resort to my technology. 

Use technology to beat technology: One thing that can shock technology users is how much time they actually spend on their mobile devices. Working out how much time is actually spent online can be the first step in wanting to cut down. (For instance, someone I once worked with was shocked to find he had spent 72 [24-hour] days in one year playing World of Warcraft). Tech users can download apps that tell them how much time spending online, (e.g., Moment). Being made aware of a problem is often the first step in enabling behavioural change.

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

Further reading

Goodnet (2013). 7 steps to planning your next digital detox. October 22. Located at: http://www.goodnet.org/articles/7-steps-to-planning-your-next-digital-detox

Hosseini, M.D. (2013). Top 10 tips to unplug this summer with a digital detox. Advertising Week Social Club, June 28. Located at: http://www.theawsc.com/2013/06/28/top-10-tips-to-unplug-this-summer-with-a-digital-detox/

Huffington Post (2013). 10 digital detox vacation hacks to help you truly unplug. July 31. Located at: http://www.huffingtonpost.com/2013/07/31/vacation-hacks-_n_3676474.html

Levy, P. (2015). 15 tips for a total digital detox. Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-17030/15-tips-for-a-total-digital-detox.html

Lipman, F. (2015). 12 tips for your next digital detox. March 2. Located at: http://www.drfranklipman.com/shake-it-off-12-tips-for-your-next-digital-detox/

Lipman, F. (2014). 8 ways to disconnect from technology and get more done. November 5. Located at: http://www.drfranklipman.com/8-ways-to-disconnect-from-technology-and-get-more-done/

South China Morning Post (2015). Five tips for a digital detox. Located at: http://www.scmp.com/lifestyle/technology/article/1673273/five-tips-digital-detox

Vozza, S. (2013). A realistic digital detox in 5 easy steps. Entrepreneur, November 12. Located: http://www.entrepreneur.com/article/229783