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“Diagnostic inflation” will not resolve taxonomical problems in the study of addictive online behaviours
Commentary on: How to overcome taxonomical problems in the study of Internet use disorders and what to do with “smartphone addiction”? (Montag et al., 2020)
Abstract
This article suggests that the type of Internet-enabled device should not be prioritised when conceptualizing diagnostic categories of addictive online behaviours. The diagnostic distinction between “predominantly mobile” and “predominantly non-mobile” forms of Internet use disorders (IUD) is not empirically based, may not be clinically useful and may lead to “diagnostic inflation.” Problems with the concepts of smartphone use disorder and IUD on which the proposed distinction is largely based call for their re-examination. Future proposals for the taxonomy of addictive behaviours may not need to be based on online/offline and mobile/non-mobile dichotomies.
Abstract
Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as ‘yes’ or ‘no’; or frequency categories, such as ‘rarely’ and ‘often’) on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms.
Abstract
Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019–2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises.
Abstract
Background and aims
It is well understood that engagement with some forms of gambling, like EGMs, is riskier than other forms. However, while reports of associations are common, few studies have attempted to evaluate and compare the relative risk of all available forms, and none have estimated the relative contribution of each form to the total burden of gambling problems (GP) in a population.
Methods
Using an aggregated dataset of national and state-based prevalence studies in Australia (N = 71,103), we estimated prevalence and unique effects of frequency of engagement on each form on GP. Two alternative numerical methods were then applied to infer the relative contribution of each form to the total amount of GP.
Results
EGMs are responsible for 51%–57% of gambling problems in Australia, and 90% of gambling problems are attributable to EGMs, casino, race, and sports betting. Casino table games and EGMs are equally risky at the individual level, but the former contribute far less to problems due to low participation. Bingo and lottery play show no statistically detectable risk for GP.
Discussion and conclusion
The results illustrate which forms present the greatest population burden and illuminate the reasons why. EGMs have an outsized impact. EGM uniquely combines high risk conditional on play, with a high participation rate and a high frequency of play among participants. This is in contrast to risky but less commonly played casino games, and prevalent but non-risky forms like lotteries. We conclude that EGM regulation should be a primary focus of policy action in Australia. More innovative policy ideas relating to EGMs should be tested due to the disproportionate impact of this product type.
