Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
The biggest challenge to the development of a comprehensive understanding of addiction comes from those forms which are not drugs and which have therefore been marginalized in the past. The excessive appetites model puts gambling, eating and sex near the centre of the picture. It is not simply that we might reluctantly permit them to the periphery of our gaze, but rather that they need to be restored to a proper, central position in order to correct the eccentricity of previous thinking that has come about as a result of attending far too closely to a limited class of addictive activities. Gambling is particularly important because of the long-standing and wide-ranging evidence of its addictiveness.
How do appetites sometimes become excessive? A crucial implication of changing the shape of the field is that we should be looking for explanations, not simply of abnormal or artificially created forms of excess, but principally of how appetites that give mainly pleasure, delight, joy or harmless entertainment can sometimes become so excessive that they threaten to spoil our lives. Let us start by considering how appetitive behaviors are distributed in the population. It is now a commonplace observation that the distribution of volume of alcohol consumption in the population produces a curve that is markedly skewed towards the higher consumption end of the distribution: the majority of people are found to conform more or less to a relatively moderate norm, with smaller and smaller proportions of people displaying consumption in excess of this norm to a greater and greater degree (Ledermann, 1956; Purser et al, 2000). There is good evidence that such a distribution is a feature of most, perhaps all, of the forms of appetitive behavior considered above. This is illustrated by data from The National Survey of Sexual Attitudes and Lifestyles carried out in Britain in the early 1990s. In relation to the numbers of people's heterosexual partners (life-time or last 5 years), Wellings et al. (1994) commented, 'One of the striking features of these data ... . [is] the marked variability between individuals in the number of partners reported, and the extreme skewness of the distribution' (p. 94). The same turns out to be the case for gambling activity in the general population as demonstrated by data from the first British National Survey of the Lottery and Other Forms of Gambling, which showed a markedly skewed distribution of numbers of different types of gambling activity participated in during the 12 months prior to the survey (Sproston, Erens & Orford, 2000). Whether the peak of such a curve, representing the mode or norm, lies at or above the zero point, and how steeply the curve falls from the modal point, will vary with the nature of the activity and the particular population. What unites all such appetitive consumption curves, however, is their very marked skewness, showing the existence of a long tail, representing minorities of people, distinguishable from the majority only quantitatively, who are involved in the activity to an extent far beyond the norm. Their appetitive behavior is excessive, at least in the statistical sense.
Deterrence and restraint: There are two general explanations for the generation of such curves. The first lies in the psychology of restraint and conformity. Nearly 70 years ago Allport (1934) noticed that certain behaviors, such as times of arrival for work or the speed of vehicles crossing intersections which carried Halt or Slow signs, followed skewed or reversed J-shaped frequency curves. He argued that this would always be the case when behavior was subject to social control. Provided this control was effective to some degree, most people would more or less conform to a norm or a rule or law governing behavior, and decreasing proportions of people would deviate to an increasingly great extent. Allport referred to the skewed curve as the conformity curve and he considered it to be the result of the imposition of conformity processes on people's inclinations to do such things as stay in bed when they should be at work, or drive fast across junctions. Many years later, Hyman (1979) pointed out that similar distributions are obtained for many geographical, social and economic variables. He put forward the hypothesis that the underlying theme of all such distributions is that of, 'major deterrences nipping the evolution of a phenomenon in the bud (though not entirely suppressing it)' (p. 345). Just as there are a number of impediments to the further development of a river tributary (competition from other tributaries, insufficient rain, excessive evaporation, hard rockbeds, etc.) or the size of cities (competition from other cities, inability to generate exports, inability to provide a wide range of services, etc.), so the evolution of appetitive behavior to higher levels of consumption might, he argued, be impeded by a variety of deterrents including (he was considering alcohol use) gastric distress, headaches and dizziness, a psychological makeup which makes intoxication seem unpleasant, family and friendship norms that proscribe heavy drinking, and competition from other activities for time and money. The idea basic to both Allport's and Hyman's explanations is that of inclination restrained: in the one case by social conformity, in the other by deterring forces of various kinds, social and otherwise. The foregoing suggests, therefore, that we should be looking for some kind of deterrent, restraint, control or conformity explanation for why it is that minorities of people indulge in appetitive behaviors to an extent that is so markedly deviant from the moderation or abstinence norms to which most of us adhere. This is a kind of pushing-down-of-natural-inclinations explanation. The idea is that, given unrestrained access to opportunities for appetitive consumption, most of us would be doing these things much more than we actually are. The idea of deterrence or control has a long history in the related field of criminology (e.g. Hirschi, 1969). Although this idea has been less explicit in the addictions field, evidence for the importance of restraint abounds. Its importance is suggested by evidence that unconventionality and non-conformity are amongst the most significant predisposing 'person' variables for appetitive behaviors among school and university students, at least within the cultures and times in which most of the research was carried out (e.g. Jessor et al., 1991); the inverse relationship so often found between religiosity and appetitive behavior (Hawkins, Catalano & Miller, 1992; Miller, 1998), evidence on the role of family members, especially women, in restraining the appetitive behavior of their loved ones (e.g. Holmila, 1988); not to mention the role of leaders and governments over the centuries in keeping their subjects' appetitive behavior under control.
Orford, J. (2001). Addiction as excessive appetite. Addiction, 96(1).
Personal Reflection Exercise #3
The preceding section contained information regarding framing gambling addiction as an excessive appetite for families. Write three case study examples regarding how you might use the content of this section in your practice.
Peer-Reviewed Journal Article References:
Angus, D. J., Pickering, D., Keen, B., & Blaszczynski, A. (2021). Study framing influences crowdsourced rates of problem gambling and alcohol use disorder. Psychology of Addictive Behaviors. Advance online publication.
Dixon, M. J., Gutierrez, J., Stange, M., Larche, C. J., Graydon, C., Vintan, S., & Kruger, T. B. (2019). Mindfulness problems and depression symptoms in everyday life predict dark flow during slots play: Implications for gambling as a form of escape. Psychology of Addictive Behaviors, 33(1), 81–90.
Kim, H. S., Sears, C. R., Hodgins, D. C., Ritchie, E. V., Kowatch, K. R., & McGrath, D. S. (2021). Gambling-related psychological predictors and moderators of attentional bias among electronic gaming machine players. Psychology of Addictive Behaviors. Advance online publication.
Leonard, C. A., Williams, R. J., & McGrath, D. S. (2021). Gambling fallacies: Predicting problem gambling in a national sample. Psychology of Addictive Behaviors. Advance online publication.