A ‘components’ model of addiction within a biopsychosocial framework

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors

OBJECTIVES

"Fast" (i.e., implicit) processing is relatively automatic; "slow" (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes.

DESIGN

We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms.

METHOD

Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms.

RESULTS

Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised.

CONCLUSION

Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.

Withdrawal symptoms in internet gaming disorder: A systematic review

Internet gaming disorder (IGD) is currently positioned in the appendix of the DSM-5 as a condition requiring further study. The aim of this review was to examine the state of current knowledge of gaming withdrawal symptomatology, given the importance of withdrawal in positioning the disorder as a behavioral addiction. A total of 34 studies, including 10 qualitative studies, 17 research reports on psychometric instruments, and 7 treatment studies, were evaluated. The results indicated that the available evidence on Internet gaming withdrawal is very underdeveloped. Internet gaming withdrawal is most consistently referred to as 'irritability' and 'restlessness' following cessation of the activity. There exists a concerning paucity of qualitative studies that provide detailed clinical descriptions of symptoms arising from cessation of internet gaming. This has arguably compromised efforts to quantify withdrawal symptoms in empirical studies of gaming populations. Treatment studies have not reported on the natural course of withdrawal and/or withdrawal symptom trajectory following intervention. It is concluded that many more qualitative clinical studies are needed, and should be prioritised, to develop our understanding of gaming withdrawal. This should improve clinical descriptions of problematic internet gaming and in turn improve the quantification of IGD withdrawal and thus treatments for harmful internet gaming.

A study on the relationship between compulsive exercise, depression and anxiety

BACKGROUND AND AIMS

Exercise and physical activity are beneficial both physically and psychologically but a few individuals use exercise excessively resulting in physical and even psychological damage. There is evidence for bi-directional relationship between exercise with depression and anxiety showing that exercise can reduce anxiety and depression, whereas a lack of exercise is associated with higher levels of anxiety and depression.

METHODS

This study used questionnaires assessing compulsive exercise, anxiety and depression among 20 professional regular exercisers and 51 recreational regular exercisers.

RESULTS

Results showed that ratings of compulsive exercise were associated with ratings of anxiety and depression among individuals who exercise for professional and recreational purpose. Secondly, individuals who exercise for professional purpose were more depressed than individuals who exercise for recreational purpose, but did not exhibit higher trait anxiety ratings. Thirdly, individuals who exercise for recreational purpose showed an association between ratings of compulsive exercise and depression but not with ratings of trait anxiety.

DISCUSSION

Individuals who exercise for professional and recreational purpose may use it as a means for alleviating depression and anxiety although this small sample of recreational and professional sportsmen showed clinical levels of anxiety and depression that may require further clinical treatment.

The Hierarchical Model of Exercise Dependence

Abstract. Physical exercise when done excessively may have negative consequences on physical and psychological wellbeing. There exist many scales to measure this phenomenon. The purpose of this article is to create a scale measuring the problematic practice of physical exercise (PPPE Scale) by combining two assessment tools already existing in the field of exercise dependency but anchored in different approaches (EDS-R and EDQ). This research consists of three studies carried out on three independent sample populations. The first study (N = 341) tested the construct validity (exploratory factor analysis); the second study (N = 195) tested the structural validity (confirmatory factor analysis) and the third study (N = 104) tested the convergent validity (correlations) of the preliminary version of the PPPE scale. Exploratory factor analysis identified six distinct dimensions associated with exercise dependency. Furthermore, confirmatory factor analysis validated a second order model consisting of 25 items with six dimensions and four sub-dimensions. The convergent validity of this scale with other constructs (GLTEQ, EAT26, and The Big Five Inventory [BFI]) is satisfactory. The preliminary version of the PPPE must be administered to a large population to refine its psychometric properties and develop scoring norms.

Possible End to an Endless Quest? Cognitive Bias Modification for Excessive Multiplayer Online Gamers

Cognitive biases have previously been recognized as key mechanisms that contribute to the development, maintenance, and relapse of addictive behaviors. The same mechanisms have been recently found in problematic computer gaming. The present study aims to investigate whether excessive massively multiplayer online role-playing gamers (EG) demonstrate an approach bias toward game-related cues compared to neutral stimuli; to test whether these automatic action tendencies can be implicitly modified in a single session training; and to test whether this training affects game urges and game-seeking behavior. EG (n=38) were randomly assigned to a condition in which they were implicitly trained to avoid or to approach gaming cues by pushing or pulling a joystick, using a computerized intervention (cognitive bias modification via the Approach Avoidance Task). EG demonstrated an approach bias for gaming cues compared with neutral, movie cues. Single session training significantly decreased automatic action tendencies to approach gaming cues. These effects occurred outside subjective awareness. Furthermore, approach bias retraining reduced subjective urges and intentions to play, as well as decreased game-seeking behavior. Retraining automatic processes may be beneficial in changing addictive impulses in EG. Yet, large-scale trials and long-term follow-up are warranted. The results extend the application of cognitive bias modification from substance use disorders to behavioral addictions, and specifically to Internet gaming disorder. Theoretical implications are discussed.

The Bergen Shopping Addiction Scale: reliability and validity of a brief screening test

Although excessive and compulsive shopping has been increasingly placed within the behavioral addiction paradigm in recent years, items in existing screens arguably do not assess the core criteria and components of addiction. To date, assessment screens for shopping disorders have primarily been rooted within the impulse-control or obsessive-compulsive disorder paradigms. Furthermore, existing screens use the terms ‘shopping,’ ‘buying,’ and ‘spending’ interchangeably, and do not necessarily reflect contemporary shopping habits. Consequently, a new screening tool for assessing shopping addiction was developed. Initially, 28 items, four for each of seven addiction criteria (salience, mood modification, conflict, tolerance, withdrawal, relapse, and problems), were constructed. These items and validated scales (i.e., Compulsive Buying Measurement Scale, Mini-International Personality Item Pool, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale) were then administered to 23,537 participants (M_age = 35.8 years, SD_age = 13.3). The highest loading item from each set of four pooled items reflecting the seven addiction criteria were retained in the final scale, The Bergen Shopping Addiction Scale (BSAS). The factor structure of the BSAS was good (RMSEA = 0.064, CFI = 0.983, TLI = 0.973) and coefficient alpha was 0.87. The scores on the BSAS converged with scores on the Compulsive Buying Measurement Scale (CBMS; 0.80), and were positively correlated with extroversion and neuroticism, and negatively with conscientiousness, agreeableness, and intellect/imagination. The scores of the BSAS were positively associated with anxiety, depression, and low self-esteem and inversely related to age. Females scored higher than males on the BSAS. The BSAS is the first scale to fully embed shopping addiction within an addiction paradigm. A recommended cutoff score for the new scale and future research directions are discussed.

Refining Measures for Assessing Problematic/Addictive Digital Gaming Use in Clinical and Research Settings

Problematic or addictive digital gaming (including all types of electronic devices) can and has had extremely adverse impacts on the lives of many individuals across the world. The understanding of this phenomenon, and the effectiveness of treatment design and monitoring, can be improved considerably by continuing refinement of assessment tools. The present article briefly overviews tools designed to measure problematic or addictive use of digital gaming, the vast majority of which are founded on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for other addictive disorders, such as pathological gambling. Although adapting DSM content and strategies for measuring problematic digital gaming has proven valuable, there are some potential issues with this approach. We discuss the strengths and limitations of current methods for measuring problematic or addictive gaming and provide various recommendations that might help in enhancing or supplementing existing tools, or in developing new and even more effective tools.

The role of workaholism in the job demands-resources model

BACKGROUND AND OBJECTIVES

The present study tries to gain more insight in workaholism by investigating its antecedents and consequences using the job demands-resources model.

DESIGN

We hypothesized that job demands would be positively related to workaholism, particularly when job resources are low. In addition, we hypothesized that workaholism would be positively related to negative outcomes in three important life domains: health, family, and work.

METHODS

The research involved 617 Italian workers (employees and self-employed). To test the hypotheses we applied structural equation modeling (SEM) and moderated structural equation modeling (MSEM) using Mplus 6.

RESULTS

The results of SEM showed a good model where workload, cognitive demands, emotional demands, and customer-related social stressors were positively related to workaholism and work-family conflict (WFC) (partial mediation). Additionally, workaholism was indirectly related to exhaustion and intentions to change jobs through WFC. Moreover, MSEM analyses confirmed that job resources (job security and opportunities for development) buffered the relationship between job demands and workaholism. Particularly, the interaction effects were statistically significant in five out of eight combinations.

CONCLUSIONS

These findings suggest that workaholism is a function of a suboptimal work environment and predicts unfavorable employee outcomes. We discuss the theoretical and practical implications of these findings.

Substance use and treatment of substance use disorders in a community sample of transgender adults

BACKGROUND

Transgender people have elevated substance use prevalence compared with the U.S. general population, however no studies have comprehensively examined the relationship of psychosocial risk factors to substance use and substance use disorder (SUD) treatment among both male-to-female (MTF) and female-to-male (FTM) transgender adults.

METHODS

Secondary data analysis of a 2013 community-based survey of transgender adults in Massachusetts (N=452) was conducted. Adjusted multivariable logistic regression models were fit to examine the relationship of four risk factor domains with SUD treatment history and recent substance use: (1) demographics; (2) gender-related characteristics; (3) mental health; (4) socio-structural factors. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (95% CI) were estimated.

RESULTS

Ten percent of the sample reported lifetime SUD treatment. Factors associated with significant increase in odds of lifetime SUD treatment alongside recent substance use (all p<0.05) were: (1) older age (aOR=1.02; 95% CI=1.01-1.04), higher educational attainment (aOR=3.59; 95% CI=2.35-5.50), low income (aOR=0.58; 95% CI=0.39-0.86); (2) MTF identity (aOR=3.03; 95% CI=1.95-4.67), gender-affirming medical care (aOR=1.99; 95% CI=1.32-3.00); (3) intimate partner violence (aOR=1.68; 95% CI=1.13-2.49), posttraumatic stress disorder (aOR=2.56; 95% CI=1.69-3.88), depression (aOR=2.30; 95% CI=1.58-3.35), mental health treatment (aOR=1.65; 95% CI=1.11-2.45); (4) discrimination (aOR=1.90; 95% CI=1.22-2.95), unstable housing (aOR=1.80; 95% CI=1.21-2.67), and sex work (aOR=2.48; 95% CI=1.24-4.95).

CONCLUSIONS

Substance use and SUD treatment among transgender adults are associated with demographic, gender-related, mental health, and socio-structural risk factors. Studies are warranted that identify SUD treatment barriers, and integrate SUD treatment with psychosocial and structural interventions for a diverse spectrum of transgender adults.

Impact Evaluation of an Addiction Intervention Program in a Quebec Prison

OBJECTIVES

This study evaluates the effects of a prison-based addiction intervention program. The evaluation is based on a multidimensional data collection that draws a portrait of the respondents’ substance use, and of their psychological/emotional, social, and judicial spheres. It measures the changes, or lack thereof, in substance use; the psychological/emotional, social, and judicial spheres; as well as the post-treatment services used.

METHOD

A quasi-experimental repeated measures design (0, 6 weeks, and 6 months) was used. Effects of the program were identified by comparing the results obtained by a group of inmates who had participated in the program (n = 80; experimental group) with those of another group who had received no intervention (n = 70; control group).

RESULTS

The preliminary results suggested a certain treatment effect related to impulsivity and psychological distress.

CONCLUSION

Although the preliminary results were promising, the experimental and control groups did not differ significantly when more robust analyses were used.

Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users

There is no consensus regarding the phenomenology, classification, and diagnostic criteria of cybersex addiction. Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli. In the current study 123 heterosexual males completed an Approach-Avoidance-Task (AAT; Rinck and Becker, 2007) modified with pornographic pictures. During the AAT participants either had to push pornographic stimuli away or pull them toward themselves with a joystick. Sensitivity toward sexual excitation, problematic sexual behavior, and tendencies toward cybersex addiction were assessed with questionnaires. Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction. Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use. The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.

An empirical investigation of dance addiction

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.

A Longitudinal Study of Adolescent Internet Addiction

Over the last decade, research on Internet addiction (IA) has increased. However, almost all studies in the area are cross-sectional and do not examine the context in which Internet use takes place. Therefore, a longitudinal study examined the role of conscientiousness (as a personality trait) and classroom hostility (as a contextual factor) in the development of IA. The participants comprised 648 adolescents and were assessed over a 2-year period (while aged 16-18 years). A three-level hierarchical linear model was carried out on the data collected. Findings revealed that (a) lower conscientiousness was associated with IA and this did not change over time and (b) although being in a more hostile classroom did not initially have a significant effect, it increased girls’ IA vulnerability over time and functioned protectively for boys. Results indicated that the contribution of individual and contextual IA factors may differ across genders and over time. More specifically, although the protective effect of conscientiousness appeared to hold, the over-time effect of classroom hostility increased the risk of IA for girls. These findings are discussed in relation to the psychological literature. The study’s limitations and implications are also discussed.

The impact of Internet-based specific activities on the perceptions of Internet addiction, quality of life, and excessive usage: A cross-sectional study

Introduction

Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants' preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use.

Methods

A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (M_age = 30 years, SD = 10.84) were recruited online via several English-speaking online forums.

Results

Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved.

Conclusions

The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

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Preferred non-work online activities were of informational and social nature.

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Online behaviors may change by manipulating the availability of online activities.

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Perceived quality of life can be affected in the absence of Internet access.

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Perception of Internet addiction may be a useful indicator of possible addiction.

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Specific online activities are associated with perceived Internet addiction.

Commentary on Muscle dysmorphia as an addiction: a response to Grant (2015) and Nieuwoudt (2015)

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.

Fortune telling addiction: Unfortunately a serious topic about a case report

BACKGROUND

Constant social change brings about new forms of behavior, such as smartphone use, social networking,indoor tanning, cosmetic surgery, etc., that could become excessive or even lead to new forms of addictive disorders.

METHODS

We report the case of a woman who starts consulting for “clairvoyance addiction”. We then discuss the addictive nature of her disorder, based on several classifications of addiction.

RESULTS

The patient fulfilled the criteria for addiction and her clinical features were typical of that of addicted people. Other differential diagnoses were discussed.

CONCLUSION

As for any addictive behavior, the interaction of several risk factors should be considered.They are related to the individual himself, but also to the object of addiction and to the socio-environmental context. In this case, all the conditions were met for fortune telling use to become addictive.

Commentary on: Muscle dysmorphia: could it be classified as an addiction to body image?

BACKGROUND

The article titled ‘Muscle dysmorphia: Could it be classified as an addiction to body image?’ used Griffiths (2005) addiction components model as the framework in which to define muscle dysmorphia (MD) as an addiction. The authors (Foster, Shorter & Griffiths, 2014) proposed that MD could be re-classified as an addiction to body image.

METHOD AND AIM

In response to the original article, the author of this commentary reflected on the ‘Addiction to body image’ model and the components of addiction as described in the context of MD. This invited commentary aimed to provide opposing viewpoints in order to give a balanced overview on the topic.

RESULTS

It appears as if the components of addictions can be used as a framework in which to define MD. However, systematic empirical evidence had not been provided for the withdrawal symptoms associated with this behavioral addiction. An opposing viewpoint is provided in response to Foster et al.’s (2014) statement that MD is different from other body dysmorphic disorders in regards to cognitive dysfunction, and therefore cannot be explained in the same way.

CONCLUSIONS

Based on the little systematic empirical evidence to date, it may be a bit premature to re-classify MD as an addiction to body image.

Muscle dysmorphia: could it be classified as an addiction to body image?

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.

Equivalência semântica e confiabilidade da versão em português da Bergen Facebook Addiction Scale

Objetivo Avaliar a equivalência semântica e a confiabilidade da Bergen Facebook Addiction Scale para o português (Brasil). Métodos O processo consistiu em cinco passos: tradução; retradução; revisão técnica e avaliação da equivalência semântica por profissionais; avaliação do instrumento por compreensão verbal por uma amostra de profissionais (n = 10) e de estudantes (n = 37); análise de consistência interna e estabilidade por meio do coeficiente de Cronbach e coeficiente de correlação intraclasse (CCI) respectivamente, em uma amostra de 359 estudantes de graduação. Resultados O instrumento apresentou no fim um excelente nível de compreensão verbal pela população-alvo, alfa de Cronbach de 0,92 e CCI de 0,81. Conclusão A versão adaptada do instrumento para o uso em nosso ambiente resultou em um instrumento equivalente do ponto de visão de equivalência semântica, assegurando a transferência do significado geral e referencial, mantendo níveis satisfatórios de confiabilidade.

Development and content validity of a screening instrument for gaming addiction in adolescents: the Gaming Addiction Identification Test (GAIT)

This study describes the development of a screening tool for gaming addiction in adolescents - the Gaming Addiction Identification Test (GAIT). Its development was based on the research literature on gaming and addiction. An expert panel comprising professional raters (n = 7), experiential adolescent raters (n = 10), and parent raters (n = 10) estimated the content validity of each item (I-CVI) as well as of the whole scale (S-CVI/Ave), and participated in a cognitive interview about the GAIT scale. The mean scores for both I-CVI and S-CVI/Ave ranged between 0.97 and 0.99 compared with the lowest recommended I-CVI value of 0.78 and the S-CVI/Ave value of 0.90. There were no sex differences and no differences between expert groups regarding ratings in content validity. No differences in the overall evaluation of the scale emerged in the cognitive interviews. Our conclusions were that GAIT showed good content validity in capturing gaming addiction. The GAIT needs further investigation into its psychometric properties of construct validity (convergent and divergent validity) and criterion-related validity, as well as its reliability in both clinical settings and in community settings with adolescents.

The role of lifestyle in perpetuating substance use disorder: the Lifestyle Balance Model

Conceptualizing aetiology underpinning an individual's substance use disorder (SUD) not only facilitates insight and understanding, but also serves to identify targets for treatment and aid practitioners in selecting the most appropriate interventions. There is now a wealth of literature on aetiology and treatment approaches, and in more recent years, also literature to support the concept of 'recovery' from a condition which was previously thought of as a chronic, relapsing condition. The burgeoning literature around research into recovery is revealing how recovery can best be defined and what factors might be associated with recovery from SUD. To add further to this growing body of literature, a new six-domain, explanatory biopsychosocial model of substance dependence and recovery, the Lifestyle Balance Model (LBM) is proposed. Based on research findings and theory reported in the literature, the LBM is a generic model depicting six domains of biopsychosocial functioning and includes within it the role of lifestyle. The LBM has been constructed as a domain model, allowing conceptualisation of the relationships between the six domain areas that perpetuate dependence and may also be associated with recovery from SUD, providing service users and clinicians with a tool for the delivery of case formulation and identification of target areas for intervention.

Internet gaming disorder, social network disorder and laterality: handedness relates to pathological use of social networks

The internet age bears new challenges that include health risks. It is agreed that excessive internet use may reach pathological levels. However, the concept of internet addiction lacks specificity and, therefore, warrants studies on its diagnostic and etiologic classification. This study was conducted to characterize the novel DSM-5 criteria for internet gaming disorder and the adapted criteria for the “social network disorder”. Based on the established association of handedness and substance use disorders, we also explored whether internet use related to laterality. For this study, 3,287 volunteers participated in the online survey and gave particulars concerning their internet use in general, internet gaming and use of social networks, laterality markers (hand, foot, eye, ear, rotational preference in gymnastics, and head turning asymmetry) and health status. Of the participants, 1.1 % fulfilled the criteria for internet gaming disorder, and 1.8 % fulfilled the criteria for social network disorder. The applied criteria were highly correlated with the time spent on the respective internet activities (p < 4 × 10⁻⁵⁶). The analyses of comorbidity and working hours support the thresholds of 5/9 criteria and ≥30 h/week spent on the internet for the classification as pathological (p < 5 × 10⁻²). Moreover, we found that left-handedness related to more affirmed criteria and longer times spent on social networks (p ≤ 4 × 10⁻²). The provided criteria proved to be user-friendly, comprehensible and well accepted. The results contribute to a better understanding of pathological internet gaming and social network use and provide evidence that biological markers of substance use disorders are involved in internet addiction.

Altered reward processing in pathological computer gamers--ERP-results from a semi-natural gaming-design

INTRODUCTION

Internet Gaming Disorder has been added as a research diagnosis in section III for the DSM-V. Previous findings from neuroscientific research indicate an enhanced motivational attention toward cues related to computer games, similar to findings in substance-related addictions. On the other hand in clinical observational studies tolerance effects are reported by patients with Internet Gaming disorder. In the present study we investigated whether an enhanced motivational attention or tolerance effects are present in patients with Internet Gaming Disorder.

METHODS

A clinical sample from the Outpatient Clinic for Behavioral Addictions in Mainz, Germany was recruited, fulfilling the diagnostic criteria for Internet Gaming Disorder. In a semi-natural EEG design participants played a computer game during the recording of event-related potentials to assess reward processing.

RESULTS

The results indicated an attenuated P300 for patients with Internet Gaming Disorder in response to rewards in comparison to healthy controls, while the latency of N100 was prolonged and the amplitude of N100 was increased.

CONCLUSIONS

Our findings support the hypothesis that tolerance effects are present in patients with Internet Gaming Disorder, when actively playing computer games. In addition, the initial orienting toward the gaming reward is suggested to consume more capacity for patients with Internet Gaming Disorder, which has been similarly reported by other studies with other methodological background in disorders of substance-related addictions.

New Concepts, Old Known Issues

Background: Following the growing concern about ‘gaming addiction', the American Psychiatric Association (APA) and numerous scholars have suggested the need for unification and consensus for the assessment of gaming addiction, which is now possible given the recent formal recognition of ‘Internet Gaming Disorder' (IGD) by the APA since its inclusion in the DSM-5. Aims: In light of this, the aim of this chapter is to present the main findings concerning the development of the Internet Gaming Disorder Test (IGD-20 Test) and the Internet Gaming Disorder Scale – Short-Form (IGDS9-SF), two newly developed psychometric tools aimed to measure the extent of gaming disorder in online and/or offline players. Conclusions: The present findings support the viability of the two newly developed measures as adequate standardized psychometrically robust tools for assessing internet gaming disorder. Consequently, the new instruments represent the first step towards unification and consensus in the field of gaming studies.

Excessive internet use in European adolescents: what determines differences in severity?

OBJECTIVES

This study investigated the differences between non-excessive, moderately excessive, and highly excessive internet use among adolescents. These differences were explored in terms of personal characteristics, psychological difficulties, environmental factors, and manner of internet use.

METHODS

A representative sample was investigated, consisting of 18,709 adolescents aged 11-16 and their parents, from 25 European countries. Excessive internet use was measured using a five item scale covering following factors: salience, conflict, tolerance, withdrawal symptoms, and relapse and reinstatement. The main data analysis utilised multinomial and binary logistic regression models.

RESULTS

The vast majority of respondents reported no signs of excessive internet use. Moderately excessive users (4.4%) reported higher emotional and behavioural difficulties, but also more sophisticated digital skills and a broader range of online activities. The highly excessive users (1.4%) differed from the non-excessive and moderately excessive users in their preference for online games and in having more difficulties with self-control.

CONCLUSIONS

Adolescents who struggle with attention and self-control and who are inclined toward online gaming may be especially vulnerable to the otherwise uncommon phenomenon of excessive internet use.

A critical review of "Internet addiction" criteria with suggestions for the future

AIMS

In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome.

METHODS

Three popular models of IA were discussed: Griffith’s components model; Young’s Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field.

RESULTS

The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans.

CONCLUSIONS

We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.