A ‘components’ model of addiction within a biopsychosocial framework

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents

AIMS

The current study explored the nature of problematic (addictive) video gaming (PVG) and the association with game type, psychosocial health, and substance use.

METHODS

Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking).

RESULTS

Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users.

CONCLUSIONS

It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers - specifically boys - showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming.

The prevalence of workaholism: a survey study in a nationally representative sample of Norwegian employees

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.

Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings

Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior. Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.

The cognitive psychology of Internet gaming disorder

Internet gaming disorder (IGD) has received nomenclatural recognition as a potential mental health disorder, despite evident variability in its core psychopathology and psychometric assessment. Although cognitive-behavioural therapy (CBT) is considered an efficacious treatment for IGD, the underlying cognitions of the disorder are not well understood. This review aimed to synthesise research evidence on Internet gaming cognition toward identification of cognitive factors underlying IGD. A systematic review of 29 quantitative studies on Internet gaming cognition and 7 treatment studies employing cognitive therapy for IGD was conducted. Four cognitive factors underlying IGD were identified. Factors included (a) beliefs about game reward value and tangibility, (b) maladaptive and inflexible rules about gaming behaviour, (c) over-reliance on gaming to meet self-esteem needs, and (d) gaming as a method of gaining social acceptance. It is proposed that IGD-related cognition may be more complex than "preoccupation" (i.e., criterion A of IGD). IGD cognition may involve the persistent overvaluation of video gaming rewards, activities, and identities, combined with a need to adhere to maladaptive rules governing use and completion of video games. Greater understanding of the proposed cognitive factors may advance clinical research agendas on identification of individuals with IGD, as well as the expansion and improvement of cognitive therapies for the disorder.

Workaholism: An overview and current status of the research

AIMS

This article addresses the stable tendency of excessive and compulsive working (i.e., workaholism). The main aim is to provide an updated oversight of the research area related to definition, prevalence, assessment, causes, outcomes, intervention as well as proposed future research directions. The target-population is both researchers and clinicians.

METHODS

The findings are identified by narratively reviewing the literature.

RESULTS

Research into workaholism has expanded over the last two decades. Several screening instruments to identify workaholics have been developed. The vast majority of these are based on seemingly atheoretical foundations, lacking convergent validity with each other and with related constructs. Research generally shows that workaholism is related to impaired health and well-being as well as to conflicts between work and family life. Workaholism is probably caused and maintained by a range of factors, although solid empirical underpinnings for suggested antecedents are currently sparse. So far no well-evaluated interventions for workaholism exist.

CONCLUSIONS

At present, workaholism as a construct lacks conceptual and empirical clarity. Future research efforts should prioritize longitudinal studies as well as studies incorporating unbiased, firm parameters of both health and behavior.

Television, video game and social media use among children with ASD and typically developing siblings

This study examined the nature of television, video game, and social media use in children (ages 8-18) with autism spectrum disorders (ASD, n = 202) compared to typically developing siblings (TD, n = 179), and relative to other activities. Parents completed measures assessing children's screen-based and other extracurricular activities. Children with ASD spent approximately 62% more time watching television and playing video games than in all non-screen activities combined. Compared with TD siblings, children with ASD spent more hours per day playing video games (2.4 vs. 1.6 for boys, and 1.8 vs. 0.8 for girls), and had higher levels of problematic video game use. In contrast, children with ASD spent little time using social media or socially interactive video games.

Video game characteristics, happiness and flow as predictors of addiction among video game players: A pilot study

AIMS

Video games provide opportunities for positive psychological experiences such as flow-like phenomena during play and general happiness that could be associated with gaming achievements. However, research has shown that specific features of game play may be associated with problematic behaviour associated with addiction-like experiences. The study was aimed at analysing whether certain structural characteristics of video games, flow, and global happiness could be predictive of video game addiction.

METHOD

A total of 110 video game players were surveyed about a game they had recently played by using a 24-item checklist of structural characteristics, an adapted Flow State Scale, the Oxford Happiness Questionnaire, and the Game Addiction Scale.

RESULTS

The study revealed decreases in general happiness had the strongest role in predicting increases in gaming addiction. One of the nine factors of the flow experience was a significant predictor of gaming addiction - perceptions of time being altered during play. The structural characteristic that significantly predicted addiction was its social element with increased sociability being associated with higher levels of addictive-like experiences. Overall, the structural characteristics of video games, elements of the flow experience, and general happiness accounted for 49.2% of the total variance in Game Addiction Scale levels.

CONCLUSIONS

Implications for interventions are discussed, particularly with regard to making players more aware of time passing and in capitalising on benefits of social features of video game play to guard against addictive-like tendencies among video game players.

Public health strategies for prevention and control of HSV-2 in persons who use drugs in the United States

BACKGROUND

Herpes simplex virus type 2 (HSV-2) affects HIV acquisition, transmission, and disease progression. Effective medications for genital herpes and for HIV/AIDS exist. Parenteral transmission of HIV among persons who inject drugs is decreasing. Reducing sexual transmission of HIV and HSV-2 among persons who use drugs (PWUD; i.e., heroin, cocaine, "speedball", crack, methamphetamine through injection or non-injection) necessitates relevant services.

METHODS

We reviewed HSV-2 sero-epidemiology and HSV-2/HIV associations in U.S.-based studies with PWUD and the general literature on HSV-2 prevention and treatment published between 1995 and 2012. We used the 6-factor Kass framework to assess relevant HSV-2 public health strategies and services in terms of their goals and effectiveness; identification of, and minimization of burdens and concerns; fair implementation; and fair balancing of benefits, burdens, and concerns.

RESULTS

Eleven studies provided HSV-2 serologic test results. High HSV-2 sero-prevalence (range across studies 38-75%) and higher sero-prevalence in HIV-infected PWUD (97-100% in females; 61-74% in males) were reported. Public health strategies for HSV-2 prevention and control in PWUD can include screening or testing; knowledge of HSV-2 status and partner disclosure; education, counseling, and psychosocial risk-reduction interventions; treatment for genital herpes; and HIV antiretroviral medications for HSV-2/HIV co-infected PWUD.

CONCLUSIONS

HSV-2 sero-prevalence is high among PWUD, necessitating research on development and implementation of science-based public health interventions for HSV-2 infection and HSV-2/HIV co-infections, including research on effectiveness and cost-effectiveness of such interventions, to inform development and implementation of services for PWUD.

The relationships between behavioral addictions and the five-factor model of personality

Aims Although relationships between addiction and personality have previously been explored, no study has ever simultaneously investigated the interrelationships between several behavioral addictions, and related these to the main dimensions of the five-factor model of personality. Methods In this study, 218 university students completed questionnaires assessing seven different behavioral addictions (i.e., Facebook addiction, video game addiction, Internet addiction, exercise addiction, mobile phone addiction, compulsive buying, and study addiction) as well as an instrument assessing the main dimensions of the five-factor model of personality. Results Of the 21 bivariate intercorrelations between the seven behavioral addictions, all were positive (and nine significantly). The results also showed that (i) Neuroticism was positively associated with Internet addiction, exercise addiction, compulsive buying, and study addiction, (ii) Extroversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying, (iii) Openness to experience was negatively associated with Facebook addiction and mobile phone addiction, (iv) Agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying, and (v) Conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying and positively associated with exercise addiction and study addiction. Conclusions The positive associations between the seven behavioral addictions suggest one or several underlying pathological factors. Hierarchical multiple regressions showed that personality traits explained between 6% and 17% of the variance in the seven behavioral addictions, suggesting that personality to a varying degree explains scores on measures of addictive behaviors.

Buddhist philosophy for the treatment of problem gambling

Purpose In the last five years, scientific interest into the potential applications of Buddhist-derived interventions (BDIs) for the treatment of problem gambling has been growing. This paper reviews current directions, proposes conceptual applications, and discusses integration issues relating to the utilisation of BDIs as problem gambling treatments. Method Aliterature search and evaluation of the empirical literature for BDIs as problem gambling treatments was undertaken. Results To date, research has been limited to cross-sectional studies and clinical case studies and findings indicate that Buddhist-derived mindfulness practices have the potential to play an important role in ameliorating problem gambling symptomatology. As an adjunct to mindfulness, other Buddhist-derived practices are also of interest including: (i) insight meditation techniques (e.g., meditation on 'emptiness') to overcome avoidance and dissociation strategies, (ii) 'antidotes' (e.g., patience, impermanence, etc.) to attenuate impulsivity and salience-related issues, (iii) loving-kindness and compassion meditation to foster positive thinking and reduce conflict, and (iv) 'middle-way' principles and 'bliss-substitution' to reduce relapse and temper withdrawal symptoms. In addition to an absence of controlled treatment studies, the successful operationalisation of BDIs as effective treatments for problem gambling may be impeded by issues such as a deficiency of suitably experienced BDI clinicians, and the poor provision by service providers of both BDIs and dedicated gambling interventions. Conclusions Preliminary findings for BDIs as problem gambling treatments are promising, however, further research is required.

Psychometric properties of the problematic online gaming questionnaire short-form and prevalence of problematic online gaming in a national sample of adolescents

The rise and growing popularity of online games has led to the appearance of excessive gaming that in some cases can lead to physical and psychological problems. Several measures have been developed to explore the nature and the scale of the phenomenon. However, few measures have been validated psychometrically. The aim of the present study was to test the psychometric properties of the 12-item Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and to assess the prevalence of problematic online gaming. Data collection was carried out to assess the prevalence of problematic online gaming in a national representative adolescent sample by using an offline (pen and pencil) method. A total of 5,045 secondary school students were assessed (51% male, mean age 16.4 years, SD=0.9 years) of which 2,804 were gamers (65.4% male, mean age 16.4 years, SD=0.9 years). Confirmatory factor analysis was applied to test the measurement model of problematic online gaming, and latent profile analysis was used to identify the proportion of gamers whose online game use can be considered problematic. Results showed that the original six-factor model yielded appropriate fit to the data, and thus the POGQ-SF has appropriate psychometric properties. Latent profile analysis revealed that 4.6% of the adolescents belong to a high risk group and an additional 13.3% to a low risk group. Due to its satisfactory psychometric characteristics, the 12-item POGQ-SF appears to be an adequate tool for the assessment of problematic online gaming.

Toward a consensus definition of pathological video-gaming: a systematic review of psychometric assessment tools

Pathological video-gaming, or its proposed DSM-V classification of "Internet Use Disorder", is of increasing interest to scholars and practitioners in allied health disciplines. This systematic review was designed to evaluate the standards in pathological video-gaming instrumentation, according to Cicchetti (1994) and Groth-Marnat's (2009) criteria and guidelines for sound psychometric assessment. A total of 63 quantitative studies, including eighteen instruments and representing 58,415 participants, were evaluated. Results indicated that reviewed instrumentation may be broadly characterized as inconsistent. Strengths of available measures include: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggests that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict. It is concluded that a unified approach to assessment of pathological video-gaming is needed. A synthesis of extant research efforts by meta-analysis may be difficult in the context of several divergent approaches to assessment.

Aristotle on drugs

This paper begins by examining the ethical issues in public health and attempts to resolve them. It then considers three different paradigms responding to heroin addiction and their underlying moral philosophy. Firstly it examines prohibition and abstinence only treatment as an example of deontological ethics and harm reduction approaches as an example of a utilitarian ethics. Policy and practice problems resulting from weaknesses in the underlying philosophies are examined along with the futile debate between abstinence only and harm reduction approaches. A third paradigm, 'recovery' is examined as an example of Aristotelian virtue ethics. The paper concludes by considering the wider implications of this case study in terms of the need for further bioethical enquiry in public health and proposes virtue ethics as a paradigm within which ethical issues can be identified and debated.

The use of online methodologies in studying paraphilias - A review

Aims The paper outlines the advantages, disadvantages, and other implications of using the Internet to collect data from those people displaying sexually paraphilic behavior. Method Using empirical and clinical studies published in the paraphilia literature, the main issues concerning online paraphilic data collection are reviewed and discussed. Results The specific online data collection methods examined included the collection of paraphilic data via (i) online questionnaires, (ii) online forums, (iii) online interviews, and (iv) online participant observation. Conclusions It is concluded that there are many useful and practical advantages of using online research methodologies to examine sexually paraphilic behavior.

Morals, medicine, metaphors, and the history of the disease model of problem gambling

Over the past 200 years, society has come to accept the idea that addictions such as alcoholism and pathological gambling (PG) are a type of disease that is chronic, progressive, and somewhat mysterious in terms of etiology. This conception has been most strongly associated with organizations such as Alcoholics Anonymous and Gamblers Anonymous. The chronic disease model alleviated stigma and encouraged many to seek help, but has been challenged by some experts. Confusing the issue is that the public health model, often presented as the main alternative to the disease model, is rooted in epidemiology and clearly a disease model itself. In this paper, we trace the history of ideas about PG as a disease and examine some of the assumptions and metaphors that underlie these models. In the final section, we examine what aspects of addiction in general, and PG in particular, are either revealed or hidden by these models.

Emerging association between addictive gaming and attention-deficit/hyperactivity disorder

Children's and adolescent's use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012.

Internet and gaming addiction: a systematic literature review of neuroimaging studies

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction. A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches.

Contextualising over-engagement in work: Towards a more global understanding of workaholism as an addiction

Purpose Despite increasing empirical research into workaholism, no single definition or conceptualisation has emerged, and current understandings of workaholism are arguably problematic. The primary purpose of this paper is to clarify some of these issues, by defining and contextualising over-engagement in work that leads to severe negative consequences (i.e., workaholism) as a genuine behavioural addiction. Approach By conceptualising work behaviours as manifestations of behavioural engagement and placing them on a continuum from withdrawal/under-engagement (e.g., persistent absenteeism) to over-engagement (e.g., work conflicting with all other activity), this paper argues that workaholism is an extreme negative aspect of behavioural engagement. It then examines the extent to which workaholism can be viewed as a genuine addiction by using criteria applied to other more traditional behavioural addictions (e.g., gambling addiction, exercise addiction), before briefly outlining an approach towards a more global understanding of workaholism. Findings The framework presented here helps to contextualise over-engagement to work as a genuine addiction. It presents more comprehensive understanding of workaholism that takes into account the individual factors of the employee, situational factors of the working environment, and structural factors of the work activity itself. It provides theoretically derived links between workaholism and other work behaviours that can be empirically demonstrated. Practical implications Viewing workaholism as an addiction that comprises extreme and prolonged behavioural over-engagement can be invaluable for promoting healthy work engagement. A clearer understanding of the underpinnings of workaholism can allow for a better assessment and management by practitioners. Originality/value This paper is one the first to contextualise workaholism in relation to other work behaviours, conceptualise it as a genuine behavioural addiction, and to apply clinical criteria for addiction to understand workaholism as prolonged and extreme behavioural engagement.

Attentional bias and disinhibition toward gaming cues are related to problem gaming in male adolescents

PURPOSE

The aim of this study was to examine whether behavioral tendencies commonly related to addictive behaviors are also related to problematic computer and video game playing in adolescents. The study of attentional bias and response inhibition, characteristic for addictive disorders, is relevant to the ongoing discussion on whether problematic gaming should be classified as an addictive disorder.

METHODS

We tested the relation between self-reported levels of problem gaming and two behavioral domains: attentional bias and response inhibition. Ninety-two male adolescents performed two attentional bias tasks (addiction-Stroop, dot-probe) and a behavioral inhibition task (go/no-go). Self-reported problem gaming was measured by the game addiction scale, based on the Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria for pathological gambling and time spent on computer and/or video games.

RESULTS

Male adolescents with higher levels of self-reported problem gaming displayed signs of error-related attentional bias to game cues. Higher levels of problem gaming were also related to more errors on response inhibition, but only when game cues were presented.

CONCLUSIONS

These findings are in line with the findings of attentional bias reported in clinically recognized addictive disorders, such as substance dependence and pathological gambling, and contribute to the discussion on the proposed concept of "Addiction and Related Disorders" (which may include non-substance-related addictive behaviors) in the Diagnostic and Statistical Manual of Mental Disorders-fourth edition.

The development of the Problematic Online Gaming Questionnaire (POGQ)

Background

Online gaming has become increasingly popular. However, this has led to concerns that these games might induce serious problems and/or lead to dependence for a minority of players. Aim: The aim of this study was to uncover and operationalize the components of problematic online gaming.

Methods

A total of 3415 gamers (90% males; mean age 21 years), were recruited through online gaming websites. A combined method of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was applied. Latent profile analysis was applied to identify persons at-risk.

Results

EFA revealed a six-factor structure in the background of problematic online gaming that was also confirmed by a CFA. For the assessment of the identified six dimensions – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal – the 18-item Problematic Online Gaming Questionnaire (POGQ) proved to be exceedingly suitable. Based on the latent profile analysis, 3.4% of the gamer population was considered to be at high risk, while another 15.2% was moderately problematic.

Conclusions

The POGQ seems to be an adequate measurement tool for the differentiated assessment of gaming related problems on six subscales.

This kind of general spectrum questionnaire was born from two early initiatives [11,20]. However, psychometric characteristics of these tools were revealed only to a very limited extent. Research exploring problems in connection with video games [12,21], either offline or online, can be regarded as related attempts. Characteristics of these games and the gamer populations differ greatly from those of Massively Multiplayer Online Games (MMOG) [22]. It is therefore both essential and necessary to develop a questionnaire that (i) measures problems related to these games, (ii) is differentiated from offline games, (iii) covers all online games, and (iv) has adequate psychometric characteristics.

Development of a Facebook Addiction Scale

The Bergen Facebook Addiction Scale (BFAS), initially a pool of 18 items, three reflecting each of the six core elements of addiction (salience, mood modification, tolerance, withdrawal, conflict, and relapse), was constructed and administered to 423 students together with several other standardized self-report scales (Addictive Tendencies Scale, Online Sociability Scale, Facebook Attitude Scale, NEO–FFI, BIS/BAS scales, and Sleep questions). That item within each of the six addiction elements with the highest corrected item-total correlation was retained in the final scale. The factor structure of the scale was good (RMSEA = .046, CFI = .99) and coefficient alpha was .83. The 3-week test-retest reliability coefficient was .82. The scores converged with scores for other scales of Facebook activity. Also, they were positively related to Neuroticism and Extraversion, and negatively related to Conscientiousness. High scores on the new scale were associated with delayed bedtimes and rising times.

Exercise addiction: symptoms, diagnosis, epidemiology, and etiology

Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.

Susceptibility to addictive behaviour in online and traditional poker playing environments

BACKGROUND AND AIMS

With the growing number of virtual sites and easy access to them, as well as increasing popularity of the game, online poker could foster addiction. The aim of the current inquiry was to gauge susceptibility to behavioural addiction in online and traditional poker players.

METHODS

Ninety-six online poker players and 35 traditional players were tested on the basis of the "Components model" for addiction (Griffiths, 2005). Using a Likert scale, ratings on six components were examined: salience, conflict, mood modification, withdrawal symptoms, tolerance, and relapse.

RESULTS

The traditional players scored higher than online players on measures of conflict, mood modification, and relapse. While none of the traditional players were at risk, the majority of them (94.7%) were symptomatic. Two online players were at risk, 67.7% symptomatic and 30.2% asymptomatic. No significant correlations have emerged between the amount and history of poker playing and the addiction scores.

CONCLUSIONS

The current findings suggest that most traditional players are prone to behavioural addiction while the majority of the online players are also symptomatic.

Clinical Interventions for Technology-Based Problems: Excessive Internet and Video Game Use

Psychological problems arising from excessive use of digital technologies, particularly in relation to the Internet and video games, are of growing clinical concern. Although there is no consensus whether technology-based problems constitute primary psychopathologies that should be recognized as clinical disorders, a significant number of problem users have used clinical treatment services. There is therefore a growing need for the mental health community to be aware of available clinical treatments for technology-based problem behaviors and the efficacy of these treatments. This article presents an overview of the prevalence of technology-based problems in Eastern and Western countries and the known cognitive-behavioral dimensions of problematic technology use. We also consider issues related to the assessment of technology-based problems, and critically review clinical treatments for technology-based problems.

Are online gamblers more at risk than offline gamblers?

OBJECTIVES

To characterize and compare sociodemographic profiles, game-play patterns, and level of addictive behaviors among adults who gamble online and those who do not, and to examine if, at the population level, online gambling is associated with more risky behaviors than offline gambling.

METHODS

Respondents were 8,456 offline gamblers and 111 online gamblers who participated in a population-based survey conducted in the province of Québec, in 2009. The study sample is representative of adult general population.

RESULTS

There is an unequal distribution of online gambling in the population. A disproportionate number of men, young people, and students say they participate in online gambling. Poker players are overrepresented among online gamblers and gambling behaviors tend to be more excessive on the Internet. Compared with offline gamblers, online gamblers report more co-occurring risky behaviors, namely alcohol and cannabis use.

CONCLUSION

Those who gamble online appear to be more at risk for gambling-related problems, but the present findings alone cannot be used as evidence for that conclusion. Future research designs could combine longitudinal data collection and multilevel analyses to provide more insight into the causal mechanisms associated with online gambling.

To use or not to use: Expanding the view on non-addictive psychoactive drug consumption and its implications

Proposing a change to the view on psychoactive drug use in non-addicts touches a sensitive issue because of its potential implications to addiction prevention, therapeutic practice, and drug policy. Commentators raised nine questions that ranged from clarifications, suggested extensions of the model to supporting data previously not regarded, to assumptions on the implications of the model. Here, we take up the suggestions of the commentators to expand the model to behavioral addictions, discuss additional instrumentalization goals, and review the evidence from laboratory animal studies on drug instrumentalization. We consider further the role of sociocultural factors and individual development in the establishment in drug instrumentalization and addiction. Finally, we clarify which implications we think this model may have. We conclude that drug instrumentalization theory can be further applied to other behaviors but will require a sensitive debate when used for drug and addiction policy that directly affects prevention and treatment.

Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States

BACKGROUND

Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States.

METHOD

We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs.

RESULTS

SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data.

CONCLUSIONS

SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.

Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction

This paper sets out to clarify the unique features of exercise addiction. It begins by examining how this addiction can be distinguished from compulsions and impulse control disorders both of which, like an addiction, involve excessive behavior that creates adverse effects. Assessment of exercise addiction also requires that clinicians be attuned to other forms of excessive behavior, especially eating disorders that can co-occur with exercise. Finally in an effort to clarify exercise addiction, this paper uses the four phases of addiction to examine the attributes of exercise that define it as a healthy habit distinct from an addiction. The paper ends with a discussion of the implications of these topics for effective assessment and treatment.

Playing video games while using or feeling the effects of substances: associations with substance use problems

This study tested the hypothesis that playing video games while using or feeling the effects of a substance—referred to herein as “concurrent use”—is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative online survey of adult video gamers conducted by Knowledge Networks, valid n = 2,885. Problem video game playing behavior was operationalized using Tejeiro Salguero and Bersabé Morán’s 2002 problem video game play (PVP) measure, and measures for substance use problems were taken from the National Survey of Drug Use and Health (NSDUH). Separate structural equation modeling analyses were conducted for users of caffeine, tobacco, alcohol, and marijuana. In all four models, concurrent use was directly associated with substance use problems, but not with PVP. Video gaming as an enthusiastic hobby was associated with substance use problems via two indirect paths: through PVP for all substances, and through concurrent use for caffeine, tobacco, and alcohol only. Results illustrate the potential for “drug interaction” between self-reinforcing behaviors and addictive substances, with implications for the development of problem use.