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A longstanding challenge in the behavioral addictions field has been determining the point at which gaming involvement becomes clinically significant problematic use. Gaming disorder (GD) and hazardous gaming as recent ICD-11 diagnoses have attracted polarized perspectives due in part to the global popularity of recreational gaming and gaming culture. The broad continuum of gaming can often be perceived differently by different parties, including gamers themselves; what might be seen as regular, harmless, and normative to some, may be considered risky and problematic by others. The ICD-11 guidelines provide some clarity by advising that gaming disorder should not be diagnosed based on persistent gaming alone; that gaming as part of a routine, developing skills, changing mood or relieving boredom, or facilitating social interaction is not sufficient for a diagnosis; and that cultural and peer group norms should be considered in diagnosis. In this paper, we examine gaming normality-disorder boundary issues in the areas of conceptualization, assessment, and interventions. Some examples of the complex personal, social, and cultural considerations that arise in gaming diagnoses are provided. We call for researchers in the addiction and health disciplines to grapple with conceptual controversy and conduct the empirical and clinical research needed to ensure that normal recreational gaming is always clearly distinguished from harm and disorder.

Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. This narrative review summarizes the current state of knowledge regarding these five (potential) disorders due to addictive behaviors. All five (potential) disorders are clinically relevant and prevalent. Behavioral addictions frequently co-occur with other mental and behavioral problems, such as depression, anxiety, and attention deficit hyperactivity disorder. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Given that behavioral addictions are prevalent, frequently co-occur with psychiatric disorders, may often go undiagnosed and untreated, and have been linked to poorer treatment outcomes, active screening and treatment are indicated. Public health considerations should be expanded, and impacts of modern technologies should be investigated more intensively. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation., Competing Interests: Drs. Brand, Demetrovics, King, Müller, and Potenza are board members of the International Society for the Study of Behavioral Addictions. Dr. Demetrovics’s university (ELTE Eötvös Loránd University) receives funding from Szerencsejáték Ltd. (the gambling operator of the Hungarian government) to maintain a telephone helpline service for problematic gambling, and his other university (University of Gibraltar) receives funding from the Gibraltar Gambling Care Foundation and donations from gambling operators through the LCCP RET process supervised by the UK Gambling Commission. Dr. Fineberg has held research or networking grants from the National Institute for Health and Care Research, COST Action, the EU, UK Research and Innovation, and Orchard; she has received travel and/or hospitality expense coverage from the British Association for Psychopharmacology, the European College of Neuropsychopharmacology, the Royal College of Psychiatrists, the International College of Neuropsychopharmacology, the International Forum of Mood and Anxiety Disorders, and the World Psychiatric Association; she has received payment from Elsevier for editorial duties and the Mental Health Academy and Children and Screens for lecturing; she leads an NHS treatment service for OCD; she is a board member for various registered charities linked to OCD; she provides expert advice on psychopharmacology to the Medicines and Healthcare Products Regulatory Agency; and she has participated in a WHO working group focusing on diagnosis and classification of obsessive-compulsive or related disorders for ICD-11. Dr. Potenza has served as a consultant for the Addiction Policy Forum, AXA, BariaTek, Game Day Data, Idorsia Pharmaceuticals, and Opiant Therapeutics and has served as a consultant and/or adviser for gambling, health care, nonprofit, and legal entities on issues related to impulse control, Internet use, and/or addictive disorders; he has been involved in a patent application with Yale University and Novartis; he has received research support from Children and Screens, the Connecticut Council on Problem Gambling, and Mohegan Sun Casino; and he has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse control disorders, and other health topics. All of the authors have performed grant reviews for research funding agencies, and/or edited journals or journal sections, and/or given academic lectures in clinical or scientific venues, and/or produced book chapters for publishers of mental health texts.

Background and Aims: The study of stigma contributes greatly to our understanding of individuals' experiences of mental disorders. Addictive disorders are often associated with public misconceptions of the disorder, which can contribute to shame, discrimination, and reticence to seek help. This review aimed to: (1) evaluate the nature, frequency, and prevalence of addiction stigma; (2) identify the correlates of addiction stigma; and (3) examine the psychometric qualities of addiction stigma measures., Methods: A search of Web of Science, PubMed, Scopus, PsycINFO, and PsycNet, had 5,515 results which were screened for eligibility using Covidence. Eligible papers were quantitative, peer-reviewed studies, which reported an outcome variable of stigma related to an addiction., Results: A total of 99 studies were included in the review, including 70 studies of substance-based addictions, 19 studies of behavioral addictions, and 10 studies which examined both. Thirteen of the 20 studies examining the impact of familiarity with addiction reported that greater familiarity was associated with lower public stigma. Studies comparing substance and behavioral addictions (n = 5) typically reported greater public stigma towards vignettes depicting substance-based addictions than for behavioral addictions. Between 22% and 40% of individuals with an addictive disorder identified stigma as a significant barrier to seeking help; however, the relative importance of stigma among other barriers was unclear., Discussion and Conclusions: Evidence for countermeasures to prevent and/or reduce stigma is currently limited. Further research on the nature and prevalence of addiction stigma is needed to inform the development of effective clinical and public health countermeasures.

Background: The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries., Objective: This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area., Methods: We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison., Results: The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling., Conclusions: Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia., (© Kristiana Siste, Daniel L King, Enjeline Hanafi, Lee Thung Sen, Adrian Adrian, Belinda Julivia Murtani. Originally published in JMIR Serious Games (https://games.jmir.org).)

Background: Sports betting is becoming increasingly common among young people in the UK and Australia. There is a need to understand how the marketing of sports betting may influence risky and pathological gambling to inform policies aimed at reducing harm. This study examines whether sports betting advertising may predict problem gambling scores among young people, while accounting for non-marketing variables., Methods: We recruited 567 participants (53.1% male) aged 18-24 years from an online research panel. Participants were eligible if they had an active betting account and regularly bet on sports. We conducted a hierarchical regression analysis to examine whether four marketing-related measures (exposure to advertising, ad-driven betting decisions, use of betting inducements, and perceived susceptibility to betting inducements) could predict PGSI scores. We controlled for several demographic, psychological, and behavioural variables, including gender, gambling participation, spend per session, participation in in-play betting, normative beliefs about sports betting, and impulsivity., Results: The study revealed that sports betting marketing was positively associated with PGSI scores after controlling for non-marketing variables. Significant marketing predictors included ad-driven betting decisions and perceived influence from betting inducements. Other significant predictors included participation in non-sports betting gambling activities, spend per session, involvement in in-play betting, and the impulsivity trait of negative urgency., Conclusion: Sports betting marketing appears to be implicated in young people's gambling problems. Specifically, young people who have gambling problems may be more likely to bet in response to advertising, and betting incentives may contribute to an intensification of their gambling behaviour. This study supports the implementation of regulations and restrictions on advertising as a measure to protect young problem gamblers., Competing Interests: Declarations Conflict of interest The authors declare no competing interests. The authors alone are responsible for the content and writing of the paper. Informed consent All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study., (© 2024. The Author(s).)

Background: In the Compensatory-Dissociative Online Gaming (C-DOG; Giardina et al., 2024) model, we proposed a continuum from compensatory to dissociative gaming involvement. This continuum represents different degrees of integration between physical and virtual environments with three core processes - Active Escapism, Escape, and Dissociation - and two peripheral processes - Gaming-Related Relaxation and Body-Mind Detachment. Here, we developed and tested a multidimensional measure based on this model., Method: We capitalized on existing items for measuring escapism and dissociation and we generated new items consistent with the hypothesized model dimensions. A total of 54 items were administered to 1,176 online gamers playing different game genres, together with measures of problematic gaming, passion for gaming, and other psychological distress indicators., Results: Exploratory and confirmatory factor analyses yielded a six-factor, 36-item structure, with multiple hierarchical regression analyses highlighting unique associations with other psychological constructs assessed., Discussion: The following factors were identified: (1) Emotional Displacement - redirection of negative emotion into the game with associated relaxation; (2) Absorption - detachment of the player from time and space while gaming; (3) Active Escapism - simulative use of the game to compensate for lack of self-confidence in reaching physical life objectives; (4) Virtual Withdrawal - maladaptive gaming to balance impaired social functioning, predicted by traumatic experiences and pervasive depression; (5) Dissociative Regulation - dysfunctional level of engagement associated with excessive anxiety; (6) Failure Escape - problematic avoidance via gaming related to fear of future failures., Conclusions: The C-DOG factors identify critical psychological processes associated with problematic gaming, with relevant research and clinical implications.

In their study, Stavropoulos et al. (2023) capitalized on supervised machine learning and a longitudinal design and reported that the User-Avatar Bond could be accurately employed to detect Gaming Disorder (GD) risk in a community sample of gamers. The authors suggested that the User-Avatar Bond is a "digital phenotype" that could be used as a diagnostic indicator for GD risk. In this commentary, our objectives are twofold: (1) to underscore the conceptual challenges of employing User-Avatar Bond for conceptualizing and diagnosing GD risk, and (2) to expound upon what we perceive as a misguided application of supervised machine learning techniques by the authors from a methodological standpoint.

Background and Aims: Mobile phone bans in secondary schools are claimed to reduce student distraction and promote learning and face-to-face socializing. Currently, the evidence on phone bans is limited. The aim of this preregistered study was to evaluate the South Australian mobile phone ban's effects on students' problematic phone use, academic engagement, school belonging, and bullying. The study also sought to identify student variables that predict phone ban compliance., Methods: As the ban was phased in over 2023, a 2 (phone ban: yes/no) × 2 (time: baseline, 1-month follow-up) repeated-measures design was employed. Students (n = 1,282 at baseline; n = 1,256 at follow-up) in Grades 7 to 12 were recruited from five public secondary schools. Surveys included measures drawn from the Longitudinal Study of Australian Children (LSAC) and the Programme for International Student Assessment (PISA)., Results: Problematic phone use was reported by 2.6% of the sample. Being older and a more frequent user of social media predicted lower phone ban compliance. Linear mixed models indicated that ban and no ban school groups did not differ significantly in terms of problematic phone use, academic engagement, and school belonging. There was slightly higher bullying in the ban group but bullying decreased significantly in both groups., Discussion: Imposing access restrictions may not affect the underlying psychological mechanisms that drive problematic phone use. Although these results indicate limited to no short-term benefits of the ban, further evaluation with more sensitive methodologies is recommended., Conclusions: Student-technology interactions in learning institutions should be continually monitored to determine the optimal balance to support student etiquette, learning, and wellbeing.

Young people are known to be highly engaged in sports betting and therefore may be particularly susceptible to the effects of gambling-related advertising. The purpose of the present study was to examine young people's recall of sports betting advertising during the 2022 FIFA World Cup. The sample consisted of 190 UK residents aged 18-24 who had watched at least one 2022 World Cup match. A cross-sectional survey was conducted to collect data on participants' recall of sports betting advertisements across several media types and for different bets and betting offers, as well as their problem gambling scores. The findings indicated that young people were able to recall a high amount of advertising for various types of bets (95.6%) and betting inducements (89.5%). A high proportion of young people recalled advertising for risky bet types and promotions, such as 64.2% for in-play betting and 68.1% for sign-up offers. Overall, higher-risk gamblers recalled encountering more advertising than lower-risk gamblers. Participants recalled encountering sports betting advertisements on social media the most (10-14 ads per week), then on internet banners and television (5-9 ads per week, respectively). Less than half (46.3%) of respondents were aware of advertising for responsible gambling tools. This study underscores the need for policy measures that limit young people's exposure to gambling advertising, particularly for products that may contribute to gambling-related harm, and that increase the promotion of responsible gambling tools., (© 2024. The Author(s).)

Objective: The purpose of this study is to describe both the common and uncommon symptoms associated with Eagle syndrome and share our experience treating a large group of patients with surgical intervention, primarily intraoral excision of the calcified stylohyoid ligament., Methods: This retrospective case series included 56 patients at least 18 years of age or older with a diagnosis of Eagle syndrome. All operations were conducted by a single surgeon at a tertiary medical center from 2015 to 2022. Charts were reviewed for demographics, prior medical/surgical history, symptoms, imaging results, operative details, and follow-up history. A phone survey inquired about presenting symptoms and symptom resolution following surgery., Results: The most common areas of pain were the ear (64.3%), underneath the angle of the mandible (50%), throat (46.4%), and neck (30.4%). Over 70% of patients reported tinnitus, dysphagia, and pain that were exacerbated by head rotation. Fifty-one of the 56 patients underwent surgical treatment, 92.2% via intraoral and 7.8% via cervical approaches. All patients (100%) reached in a phone survey stated that their symptoms resolved or improved after surgery., Conclusion: Eagle syndrome typically presents with common symptoms. However, healthcare providers must also be vigilant for less common manifestations, such as seizures or episodes of dizziness/fainting. These may be caused by calcification of the stylohyoid ligament. Intraoral surgical resection of the calcified ligament is a safe and effective treatment for most patients., Level of Evidence: Level 4., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background and Objectives: As the gaming industry experiences exponential growth, concerns about gaming disorder (GD) also grow. It is crucial to understand the structural features of games that can interact with individual characteristics of gamers to promote GD. This research consolidates the views of an international body of panelists to create an assessment tool for gauging the addictive potential of distinct games., Methods: Utilizing the iterative and structured Delphi method, an international panel of researchers, clinicians, and people with lived experience were recruited to offer a multifaceted viewpoint on the addictive risk associated with specific structural elements in games. Two rounds of surveys facilitated consensus., Results: The panel initially included 40 members-ten from research, eight from clinical settings, and 22 with lived experiences. The second round included 27 panelists-seven from research, eight from clinical settings, and 11 with lived experiences. The study identified 25 structural features that contribute to potentially addictive gaming patterns., Discussion and Conclusions: Consensus was found for 25 features, which were distilled into a 23-item evaluation tool. The Saini-Hodgins Addiction Risk Potential of Games Scale (SHARP-G) consists of five overarching categories: 'Social,' 'Gambling-Like Features,' 'Personal Investment,' 'Accessibility,' and 'World Design.' SHARP-G yields a total score indicating level of addiction risk. A case study applying the scale to three games of differing perceived risk levels demonstrated that that score corresponded to game risk as expected. While the SHARP-G scale requires further validation, it provides significant promise for evaluating gaming experiences and products.

Abstract: Stahl, CA, Regni, G, Tanguay, J, McElfresh, M, Trihy, E, Diggin, D, and King, DL. A biomechanical comparison of the back squat and hexagonal barbell deadlift. J Strength Cond Res 38(5): 815-824, 2024-Coaches often use different exercises to encourage similar strength adaptations and limit monotony. Anecdotally, the hexagonal barbell deadlift (HBD) exhibits similarities to the back squat (BS). To date, research has not examined the empirical differences between these exercises. This study examined kinematic and kinetic differences between the BS and the HBD across different loads. Sixteen resistance-trained individuals (6 men and 10 women) volunteered to participate. Subjects performed 1-repetition maximum (1RM) testing under BS and HBD conditions. Kinematic and kinetic data were collected during performance of both exercises at submaximal (warm-up sets) and maximal (1RM) loads using a 3D motion capture and force-plate system. Results showed that subjects lifted greater 1RM loads in the HBD relative to the BS (p < 0.05; d = -1.75). Kinematic data indicated that subjects exhibited greater maximum forward lean of the trunk and decreased maximum knee flexion while performing the HBD compared with the BS. The BS resulted in higher maximum extension moments at the hip joint than the HBD. Maximum extension moments at the knee joint showed no difference between the exercises. Data suggest that bar design and position facilitate balanced moment arm length at hip and knee joints during performance of the HBD. By contrast, bar position during performance of the BS increases moment arm length at the hip joint, making it a hip-dominant exercise. The present data have implications for the programming of both exercises. Future research should examine differences in muscle-activation strategies between the 2 exercises., (Copyright © 2024 National Strength and Conditioning Association.)

The concept of impaired control (IC) over gaming is an important element of assessment and interventions for problem gaming and gaming-related harm. Past studies have reported that gaming disorder (GD) is associated with various negative consequences, but there is limited research on the relationship between IC over gaming and negative outcomes. To address this gap, the study investigated the relationship between impaired control and gaming-related harm among individuals with self-identified gaming disorder. It was hypothesized that IC would be positively associated with gaming-related harm and harm severity. In addition, it was predicted that IC would be a significant predictor of harm when controlling for age, gender, psychological distress, and gaming urges. The current study recruited 513 participants through an online survey platform. The Impaired Control Over Gaming Scale (ICOGS) was used to measure IC, and modified items from Browne et al.'s taxonomy of gambling harms were used to assess gaming harm severity. The logistic regression results showed that IC was positively related to all forms of harm, after controlling for other variables. The predictive value of IC was similar across financial, psychological, relationship, social and work/school domains. These results supported the importance of IC as a mechanism that contributes to the experience of gaming-related harm, and the need to target IC in interventions for GD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.)

Objective: The vascular anatomy of the proximal subscapular artery has been previously classified into 2 major types depending on the presence of a common subscapular trunk. The purpose of this study was to determine the utility, reliability, and cost of routine chest imaging to identify these anatomical variations., Methods: Data were collected retrospectively at a tertiary medical center for patients who were undergoing CT chest for various indications between October 2019 and October 2020. Two independent and blinded readers interpreted CT chest with contrast of 52 patients for a total 104 sides., Results: The proximal branching pattern of the subscapular system was identified to have a common trunk in 99 (95%) sides. The remaining five sides (5%) demonstrated two arterial pedicles; with one patient exhibiting the variant anatomy bilaterally., Conclusion: Preoperative CT chest with contrast can accurately identify anatomic variation of the subscapular vascular system. For complex reconstruction requiring a single anastomosis in the vessel depleted neck, preoperative imaging can assure selection of a type I vascular anatomy of the proximal subscapular system. Preoperative imaging with contrasted CT has value in assessing this anatomy when planning for chimeric flaps involving circumflex scapular and thoracodorsal arteries., Level of Evidence: 3 Laryngoscope, 134:684-687, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Background and Aims: Internet addiction has been linked to ADHD-related symptoms. However, the direction of the relationship and its potential for reciprocal relations is not well understood. This study examined the potential reciprocal relations between the three components of ADHD and Internet addiction, as well as the moderating effects of gender on these relations., Methods: Using a longitudinal design, we collected data of 865 Chinese adolescents across three waves (Mage = 13.78, SD = 1.56 in wave 1), with a time interval of 6 months., Results: Cross-lagged analyses revealed bidirectional associations between hyperactivity, inattention, impulsivity, and Internet addiction over time. Multi-group analyses did not yield any significant gender differences in these relationships., Discussion and Conclusions: These findings enhance our understanding of the complex link between ADHD components and Internet addiction and have implications for interventions aimed at reducing the prevalence of Internet addiction and ADHD.

Behavior frequency measures in behavioral addictions research fail to account for how engagement in the activity relates to each respondent's personal circumstances. We propose a "Red Box, Green Box" method, an alternative to conventional self-report behavior questions. Participants report two distinct time-based values: (1) Green box: time spent engaged in the activity during 'free' time, and (2) Red box: engagement in the activity at times when the respondent should be doing something else (e.g., studying, working, sleeping, exercising, etc.). Some practical examples of the 'red box, green box' method are provided. This method may help to calibrate behavioral frequency for each respondent and yield clearer insights into displacement effects and risks associated with frequency of use. We suggest some future research directions to test the feasibility and utility of this approach in different implementations.

Objective: Despite growing recognition of gaming disorder as a mental disorder, there is still debate about how best to screen for it. This is especially relevant in countries where prevalence studies that could support evidence-based policymaking have not yet been conducted. This study aims to evaluate the psychometric properties of the Brazilian Portuguese version of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and to explore its association with functional impairment., Methods: An online convenience sample of 805 Brazilian adults who reported playing games completed the adapted version of the IGDT-10 and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), as well as the Problematic Internet Use Questionnaire (PIUQ), the Center for Epidemiologic Studies-Depression Scale (CES-D), the Rosenberg Self-Esteem Scale (RSES), and a socio-demographic questionnaire., Results: The Brazilian Portuguese version of the IGDT-10 demonstrated a unidimensional structure in both confirmatory and exploratory factor analyses with satisfactory internal consistency and adequate temporal stability. Participants who scored five or more on the IGDT-10 presented higher levels of functional impairment compared to those who scored positive for four symptoms or fewer. The difference between the two groups was statistically significant with a moderate effect size. Network analysis showed a direct connection between IGDT-10 scores and functional impairment and identified "negative consequences" as the most relevant item connecting these variables., Conclusion: The IGDT-10 is a brief, easy-to-understand, valid, and reliable instrument, proving to be a suitable candidate for screening gaming disorder in future epidemiological studies., Competing Interests: No conflicts of interest declared concerning the publication of this article.

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.

Social chatbots powered by artificial intelligence (AI) may be particularly appealing to individuals with social deficits or conditions that affect their social functioning. In this letter, we discuss some of the noteworthy characteristics of social chatbots and how they may influence adaptive and maladaptive behaviors, including the potential for 'dependency' on chatbots. We call for more independent studies to evaluate the potential developmental and therapeutic effects of this increasingly popular technology.

Background and Aims: Problematic Internet use (PIU) has become a global public health problem. It has been suggested that parenting style is associated with adolescent PIU. However, the evidence in favor of this view is mixed. Based on the PRISMA method, the present study employed three-level meta-analysis approach to investigate the relationship between these two variables and further explore potential moderators., Methods: After a systematic search for published articles, 35 studies were included, reporting 171 effect sizes (N = 40,587)., Results: The results showed that positive parenting styles were significantly negatively related to PIU. This association was moderated by gender, age, publication year, and measurements of PIU, but was not by culture and measurements of parenting styles. Negative parenting styles were significantly positively related to PIU, which was moderated by publication year, culture, and sub-types of negative parenting, but not by gender, age, and measurements of both parenting styles and PIU. In addition, the correlation of PIU with negative parenting styles was stronger than that with positive parenting styles., Discussion and Conclusions: The present results demonstrated that parenting styles, especially punitive parenting styles, should be attached to more important when treating adolescent PIU.

This systematic review summarizes empirical evidence on risky decision-making (objective risk and ambiguity) in specific domains of problematic use of the internet (PUI) focusing on online addictive behaviors. We conducted a pre-registered (PROSPERO: CRD42020188452) PubMed search for PUI domains: gaming, social-network use, online buying-shopping, online pornography use, and unspecified PUI. We used the Newcastle-Ottawa Scale for quality assessment. Relevant studies were identified only for gaming (n = 19), social-network use (n = 8), unspecified PUI (n = 7), and online gambling (n = 1). The meta-analyses included 25 studies (2498 participants) comparing PUI and control groups regarding decision-making performance under objective risk and ambiguity. Across PUI domains, individuals with PUI compared to control participants showed more disadvantageous decision-making in measures of objective risk (g = -0.42 [-0.69, -0.16], p = .002) but not ambiguity (g = -0.22 [-0.47, -0.04], p = .096). PUI domain and gender were significant moderators. In the risk domain, effects were particularly present in gaming disorder, especially in exclusively male samples. Overall, the paucity of empirical studies in the considered area necessitates further research to identify probable gender- and disorder-specific cognitive relationships., Competing Interests: Competing interests SMM, EW, KI, MNP, SRC, and MB are (co-)authors of studies (n = 8) included in this review. MB, KI, and SRC are members of the “European Network for Problematic Usage of the Internet” (CA16207) supported by COST (European Cooperation in Science and Technology). KI and SRC receive honoraria from Elsevier for editorial work at Comprehensive Psychiatry (KI & SRC), and Neuroscience & Biobehavioral Reviews (SRC) journals. MNP has consulted for Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data, Baria-Tek and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; has received research support (to Yale) from Mohegan Sun Casino, Children and Screens and the Connecticut Council on Problem Gambling; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse-control disorders or other health topics; has consulted for and/or advised gambling, non-profit and legal entities on issues related to internet-use/impulse-control/addictive disorders/behaviors; has performed grant reviews for research-funding agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers., Design: This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design., Setting: An international sample of participants was recruited via Prolific in June and July 2021., Participants: Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD., Intervention and Comparator: Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation)., Measurements: The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference)., Findings: Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence)., Conclusions: Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming., (© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction"., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Background: Electronic gaming machines (EGMs) are one of the most harmful forms of gambling at an individual level. It is unclear whether restriction of EGM functions and accessibility results in meaningful reductions in population-level gambling harm., Methods: A natural policy experiment using a large (N = 15,000) national dataset weighted to standard population variables was employed to compare estimates of gambling problems between Australian residents in Western Australia (WA), where EGMs are restricted to one venue and have different structural features, to residents in other Australian jurisdictions where EGMs are widely accessible in casinos, hotels and clubs. Accessibility of other gambling forms is similar across jurisdictions., Results: Gambling participation was higher in WA, but EGM participation was approximately half that of the rest of Australia. Aggregate gambling problems and harm were about one-third lower in WA, and self-reported attribution of harm from EGMs by gamblers and affected others was 2.7× and 4× lower, respectively. Mediation analyses found that less frequent EGM use in WA accounted for the vast majority of the discrepancy in gambling problems (indirect path = -0.055, 95% CI -0.071; -0.038). Moderation analyses found that EGMs are the form most strongly associated with problems, and the strength of this relationship did not differ significantly across jurisdictions., Discussion: Lower harm from gambling in WA is attributable to restricted accessibility of EGMs, rather than different structural features. There appears to be little transfer of problems to other gambling forms. These results suggest that restricting the accessibility of EGMs substantially reduces gambling harm.

Background and Aims: Many new digital gambling-like activities such as loot boxes, esports betting, skin betting, and token wagering have recently emerged and grown in popularity. This scoping review aimed to: (a) synthesize the existing empirical research literature on gambling-like activities and their associations with gambling and video gaming behaviors, including problem gambling and video gaming; (b) identify sociodemographic, psychological, and motivational factors associated with engagement in gambling-like activities; and (c) identify research gaps and areas for further research., Methods: A systematic search of Ovid, Embsco, and ProQuest databases and Google Scholar was conducted in May 2021 and last updated in February 2022. The search yielded a total of 2,437 articles. Articles were included in the review if they were empirical studies that contained quantitative or qualitative results regarding the relationship between gambling-like activities and gambling or gaming., Results: Thirty-eight articles met inclusion criteria and were included in the review. Overall, the review results suggest that all forms of gambling-like activities were positively associated with gambling and gaming with small to medium effects. Gambling-like activity participation was also positively associated with mental distress and impulsivity. Gaps identified included a lack of inquiry into skin betting and token wagering, a lack of diversity in the research methods (i.e., mainly cross-sectional surveys), and a paucity of research that includes more ethnically, culturally, and geographically diverse populations., Discussion: Longitudinal studies with more representative samples are needed to examine the causal link between gambling-like activities and gambling and video gaming.

Background and Aims: The concept of impaired control is central to addictive disorders, including gaming disorder in the DSM-5 and ICD-11. Impaired control refers to the recurrent inability to resist impulses to engage in certain activities or behaviours and the failure to limit or stop this engagement. Although numerous screening tools for gaming disorder symptoms have been developed, these instruments have limited capacity for measuring the nature and extent of impaired control. To address this limitation, the present study reports on the creation of the Impaired Control Over Gaming Scale (ICOGS), an 8-item screening tool to assess gaming-related impaired control., Methods: A total of 513 gamers, including 125 gamers (24.3%) who met the DSM-5 criteria for gaming disorder, were recruited from Prolific, an online crowd-sourcing platform., Results: The ICOGS demonstrated promising psychometric properties. Exploratory and confirmatory factor analysis using two samples provided robust support for a 2-factor model and high internal consistency of the scale. ICOGS scores were significantly and positively associated with gaming disorder symptoms, gaming-related harms, gaming frequency, psychological distress, and neuroticism. Using receiver operating characteristic analysis, the ICOGS differentiated between non-problem gamers and those who met the criteria for GD., Discussion and Conclusions: Overall, the ICOGS appears to be a valid and reliable scale for use in studies of problem gaming, and may be useful for assessing outcomes of GD interventions that employ self-regulation and stopping techniques to reduce or eliminate problem gaming behavior., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

This study aimed to examine gambling motivations for esports betting and skin gambling and their association with gambling frequency, problems, and harm. Data were collected via a cross-sectional online survey with 736 participants aged 18 + who engaged in esports cash betting (n = 567), esports skin betting (n = 180), or skin gambling on games of chance (n = 325). Respondents were asked to rate their motivations for the three activities across seven domains: social, financial, positive feelings or enhancement, internal regulation, skill building, competition/challenge, and skin acquisition. The results highlight both similarities and differences in gambling motivations across products. Financial gain and enhancement (i.e., excitement) were the main motivations endorsed for all activities, whereas skin acquisition was an additional motivation for esports skin betting and skin gambling. Across all three products, gambling to escape or improve mood was associated with higher levels of problem gambling and harm. Financial gain motivation was associated with problem gambling only for esports skin betting and skin gambling on games of chance. These findings underscore the importance of considering motivational influences on engagement with emerging gambling activities, especially since some motivations may be a contributing factor in harmful gambling outcomes., (© 2022. The Author(s).)

Esports betting and skin gambling involve betting on the outcomes of video game competitions and/or using virtual currencies for betting. The present study evaluated a conceptual model linking video game involvement, video-game related gambling, traditional gambling, and gambling problems and harm. Data were collected via a cross-sectional online survey with 737 participants aged 18 + who engaged in esports cash betting (n = 576), esports skin betting (n = 184), or skin gambling on games of chance (n = 330). The findings highlighted the distinctly different relationships esports cash betting versus skin gambling had with traditional gambling involvement and harmful gambling. Gambling with skins on games of chance was predictive of gambling problems and gambling harm after controlling for participation in traditional gambling (OR = 1.32 and 1.17 respectively). Whereas betting on esports with cash was associated with betting on a variety of other forms of gambling, and there was no unique contribution to problems and harm over and above participation on these other forms (e.g., EGMs, sports betting). Skin gambling is directly implicated in gambling problems and harm, whereas cash betting on esports is only indicative of interest in many forms of potentially harmful gambling. Greater research attention to skin gambling is warranted, and particularly with respect to its role as a virtual currency more easily accessible for gambling., (© 2022. The Author(s).)

Background and Aims: Limited research has investigated how individuals' problem gaming affects significant others. The present study investigated the extent to which partners and parents were personally affected by their partner or child's problematic gaming behavior and what steps, if any, were taken in relation to treatment and other help-seeking by the gamers and the respondents themselves., Methods: Two targeted samples (parents, n = 104; partners, n = 264) in Australia were recruited and administered an online survey. The survey assessed gaming-related harm across multiple domains, including financial, relationship, emotional wellbeing, physical health and work/study. Treatment and help-seeking questions referred to seeking psychological assistance, self-help, and community support. Non-parametric tests compared groups on harm measures based on GD status., Results: Parents and partners of individuals rated in the 'problem gaming' range reported significantly greater harms compared to those in the at-risk and non-problem categories. The most frequently endorsed harms were in the relationship domain, including neglected household responsibilities, withdrawal from social events, and relationship conflict. Some parents consult with friends and family (15%) to resolve their child's gaming-related problems. Partners reported to seek outside support and assistance for themselves, including 30% who sought a psychologist. No partners reported having consulted a psychologist for their gaming partner., Discussion: Problem gaming affects significant others across multiple life areas, but few seek outside help or support, suggesting there may be significant unmet needs., Conclusions: Further research should examine factors that influence acceptance and engagement with problem gaming help options. Harm indicators may be useful for evaluating targeted interventions and other measures to reduce problem gaming.

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2023.)

The structural addictive characteristics of gambling products are important targets for prevention, but can be unintuitive to laypeople. In the PictoGRRed (Pictograms for Gambling Risk Reduction) study, we aimed to develop pictograms that illustrate the main addictive characteristics of gambling products and to assess their impact on identifying the addictiveness of gambling products by laypeople. We conducted a three-step study: (1) use of a Delphi consensus method among 56 experts from 13 countries to reach a consensus on the 10 structural addictive characteristics of gambling products to be illustrated by pictograms and their associated definitions, (2) development of 10 pictograms and their definitions, and (3) study in the general population to assess the impact of exposure to the pictograms and their definitions (n = 900). French-speaking experts from the panel assessed the addictiveness of gambling products (n = 25), in which the mean of expert's ratings was considered as the true value. Participants were randomly provided with the pictograms and their definitions, or with a standard slogan, or with neither (control group). We considered the control group as representing the baseline ability of laypeople to assess the addictiveness of gambling products. Each group and the French-speaking experts rated the addictiveness of 14 gambling products. The judgment criterion was the intraclass coefficients (ICCs) between the mean ratings of each group and the experts, reflecting the level of agreement between each group and the experts. Exposure to the pictograms and their definition doubled the ability of laypeople to assess the addictiveness of gambling products compared with that of the group that read a slogan or the control group (ICC = 0.28 vs. 0.14 (Slogan) and 0.14 (Control)). Laypeople have limited awareness of the addictive characteristics of gambling products. The pictograms developed herein represent an innovative tool for universally empowering prevention and for selective prevention., (© 2022. The Author(s).)

Objective: Evaluate barriers that deter adult patients from following through with cochlear implantation., Study Design: Retrospective chart review and phone survey., Setting: Single tertiary referral center., Patients: Between January 2019 and August 2021, 113 patients, without a previous cochlear implant (CI), were determined to be candidates for cochlear implantation. Thirty-eight (33.6%) patients deferred cochlear implantation. Survey response rate was 61.1% (22/36)., Intervention: None., Main Outcome Measures: Demographic, socioeconomic, otologic history, and comorbidity factors associated with deferment of cochlear implantation. Patient survey assessment of factors that had the greatest impact, rated on a scale of 1 to 10 (10 being the most impactful), on their decision to defer a CI., Results: Out of the 113 patients who met inclusion criteria, 75 (66.3%) underwent cochlear implantation and 38 (33.6%) patients deferred. Comparing implanted versus deferred groups, there was no statistical difference in age (67.1 y versus 68.5 y; p = 0.690) or male sex (53.3% versus 57.9%; p = 0.692). The deferred group had higher mean neighborhood disadvantage state decile (5.3 versus 4.3; p = 0.064) and national percentile (73.0 versus 66.2; p = 0.106) scores, although neither were statistically significant. A greater proportion of the deferred group were not living independently at time of CI evaluation (13.2 versus 2.7%; p = 0.017). Fear of losing residual hearing was rated the highest among the survey respondents (mean rating of 5.1), followed by general medical health (4.9) and cost and financial concerns (3.6)., Conclusion: The greatest concern among the patients was the fear of losing residual hearing. Spending greater time educating patients about the success and failure rates of cochlear implantation may reduce patient hesitancy with implantation., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

The validity of the constructs of problematic Internet or smartphone use and Internet or smartphone addiction has been extensively debated. The spectrum hypothesis posits that problematic online behaviors (POBs) may be conceptualized within a spectrum of related yet distinct entities. To date, the hypothesis has received preliminary support, and further robust empirical studies are still needed. The present study tested the spectrum hypothesis of POBs in an Australian community sample (n = 1,617) using a network analysis approach. Psychometrically validated self-report instruments were used to assess six types of POBs: problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, and problematic online gambling. A tetrachoric correlation matrix was computed to explore relationships between online activities and a network analysis was used to analyze relationships between POBs. Correlations between online activities were positive and significant, but of small magnitude (0.051 ≤ r ≤ 0.236). The community detection analysis identified six distinct communities, corresponding to each POB, with strong relationships between items within each POB and weaker relationships between POBs. These findings provide further empirical support for the spectrum hypothesis, suggesting that POBs occur as distinct entities and with little overlap., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The boundary between highly engaged and problematic video gaming is often debated in the behavioral addictions field. The present study assessed whether quality of life, motivational and protective factors may differentiate high-frequency gamers (i.e., those who play 30 + hours per week) who did, and did not, meet the DSM-5 criteria for gaming disorder (GD). A total of 403 respondents completed an online survey including standard measures of GD, gaming motivation, quality of life (QOL), and protective factors for behavioral addiction (e.g., adequate sleep and healthy diet). Respondents with GD scored lower on all QOL measures and were more strongly motivated to use gaming to escape problems. Fewer protective factors were identified in GD cases, with an inability to balance gaming with sleep being the largest significant difference between the two groups. High-frequency gaming appears most likely to be problematic if it is used to escape real-world problems or prioritized over important everyday activities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated., Objective: This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior., Methods: A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool., Results: The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms., Conclusions: Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials., (©Jennifer J Park, Daniel L King, Laura Wilkinson-Meyers, Simone N Rodda. Originally published in JMIR Mental Health (https://mental.jmir.org), 09.09.2022.)

Background and Aims: Play-to-earn (P2E) gaming is a newly emerging form of gaming increasingly based on blockchain technology. In this paper, we examine the mechanics and business model of these games and their potential benefits and risks for players., Methods: The paper draws upon and critically synthesises the developing published literature on predatory monetization in gaming as well as objective market data drawn from credible online sources., Results: P2E gaming blurs the boundaries between gaming and trading and may not yield many of the benefits promoted to consumers or otherwise conveyed through marketing and social media messaging. Particular risks include the deflationary nature of reward currencies and the asymmetric reward structures that heavily favour early investors and exploit late adopters., Discussion and Conclusions: This paper highlights the need for greater consumer awareness of the mechanics and risks of these new gaming models. It will be important for business models to be more transparent and designed so as to encourage more equitable game outcomes, sustainable returns, a balance between intrinsic and extrinsic rewards, and protection for potentially vulnerable players.

Simulated gambling, such as playing a virtual slot machine for points rather than money, is increasingly part of the online gaming experience for youth. This study aimed to examine (1) if youth participation in simulated gambling games is associated with participation in monetary gambling; (2) if youth participation in simulated gambling games is associated with increased risk of problematic gambling when controlling for breadth of monetary gambling (i.e., number of gambling forms); and (3) if monetary expenditure and time spent playing simulated gambling games increase the risk of problematic gambling. Two samples of Australians aged 12-17 years were recruited-826 respondents through an online panel aggregator (mean age 14.1 years) and 843 respondents through advertising (mean age 14.6 years). Aim 1 was addressed using chi-square and correlation analyses. Linear multiple regression analyses were conducted to address Aims 2 and 3. The findings in both samples supported the study's hypotheses-that (1) youth who play simulated gambling games are more likely to participate in monetary gambling, and that (2) participation and (3) time and money expenditure on simulated gambling are positively and independently associated with risk of problematic gambling when controlling for the number of monetary gambling forms, impulsivity, age and gender. To better protect young people, simulated gambling should, at minimum, emulate the consumer protection measures required for online gambling.

Background and Aims: The popularity of video gaming has generated significant interest in research methods to examine motivations for gaming. Current measures of gaming motives are limited by lack of scope and/or their applicability to specific game genres only. We aimed to create a comprehensive motivation inventory applicable to any gaming genre and to evaluate its psychometric properties in a large sample of highly engaged video gamers., Methods: Stage 1 of this project involved a systematic review that generated the items for the Gaming Motivation Inventory (GMI). Stages 2-4 involved an evaluation of the psychometric properties of the GMI. A sample of 14,740 video gamers (89.3% male; mean age 24.1 years) were recruited via an online survey promoted by a popular gaming magazine., Results: In Stage 2, twenty-six gaming motives were identified, which clustered into six higher-order dimensions (Mastery, Immersion/Escapism, Competition, Stimulation, Social, Habit/Boredom). In Stage 3, construct validity of the six higher-order motives was assessed by associations with gaming-related, personality, and psychological variables. In Stage 4, the relationships between motives and depression symptoms and gaming disorder symptoms were explored. Although gaming motives had weak associations with gaming genres, they were moderately related to variables such as competitiveness, sociability, and positive and negative affect. Gaming disorder symptoms were directly predicted by depression symptoms and indirectly via Immersion/Escapism, Habit/Boredom, and Competition motives., Discussion and Conclusions: These findings support the notion that motives are one of the primary causes of gaming behavior and play an important role in predicting its problematic nature. The GMI is a psychometrically valid tool that will be useful for gaining insights into factors underlying gaming behaviors.

Background and Aims: Previous research has identified numerous risk and protective factors of adolescent problematic gaming (PG) at the individual and social levels; however, the influence of socio-economic indicators on PG is less known. This study aimed to measure the contribution of individual and socio-economic factors involved in PG risk among adolescents from 30 European countries., Design: Multi-level logistic regression analysis of survey data from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study using self-administered anonymous questionnaires., Setting: Thirty European countries., Participants: A representative cohort of 15-16-year-old students (n = 88 998 students; males = 49.2%)., Measurements: The primary outcome measure was adolescents' (low and high) risk of PG. Individual key predictors included self-report assessments of socio-demographic characteristics, time spent gaming and family variables (parental regulation and monitoring, family support). Main country-level predictors comprised Gini coefficient for economic inequalities and benefits for families and children (% gross domestic product), retrieved from international public data sets and national thematic reports. The data analysis plan involved multi-level logistic regression., Findings: Participants who reported stronger parental regulation [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.79-0.83] and higher family support (OR = 0.93, 95% CI = 0.91-0.95) reported lower risk of PG. At the country-level, economic inequalities (OR = 1.05, 95% CI = 1.03-1.07) were positively associated with the risk of PG, while benefits for families and children (OR = 0.78, 95% CI = 0.70-0.89) were negatively correlated with the risk of PG., Conclusions: Supportive family environments, lower country-level economic inequalities and higher government expenditures on benefits for families and children appear to be associated with a lower risk of problematic gaming among European adolescents., (© 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Aims: Mobile gaming is a dominant form of gaming, known for its portability and for game characteristics that motivate continuous play and spending. Such involvement may also turn problematic, but research on problem gaming (PG) has tended to focus on non-mobile forms of gaming. The study was based on a cross-sectional observational design where students in upper secondary schools were recruited to a survey about mobile gaming. The age of the respondents ranged from 16 to 23 years ( n  = 519; 52.4% men; mean age = 17.2 years, SD  = 1.1). Methods: We examined (1) gaming frequency, gaming contexts, and in-game spending in relation to PG; (2) gaming context in relation to academic achievement and sleep quality; and (3) PG according to gaming platform (i.e., playing on mobile, console/computer, or mixed platforms) with Kruskal-Wallis tests, chi-square tests and Spearman rank-order correlations. Results: PG was positively associated with mobile gaming hours per week (η 2  = .02, p  < .01), minutes per session (η 2  = .03, p  < .001), making in-app purchases (Cramer's V = .15, p  < .05), and gaming during homework (Cramer's V = .14, p  < .05). Statistically significant associations were found between mobile gaming in bed and later sleep midpoint for weekdays ( r s  = .18, p  < .001) and weekends ( r s  = .11, p  < .05). Mixed platform gamers had increased likelihood of PG, console/computer gamers had increased likelihood of being at risk for PG, and mobile gamers had lower risk for PG (Cramer's V = .18, p  < .001). Conclusion: Future studies should include specific measures of mobile gaming as it appears implicated in problem gaming, albeit to a lesser degree than console and computer gaming., Competing Interests: Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background and Aims: Gambling-related harm to concerned significant others (CSOs) is an important public health issue since it reduces CSOs' health and wellbeing in numerous life domains. This study aimed to 1) estimate the first national prevalence of CSOs harmed by gambling in Australia; 2) identify the characteristics of CSOs most at risk of harm from another person's gambling; 3) compare the types and number of harms experienced by CSOs based on their relationship to the person who gambles; and 4) compare the number of harms experienced by CSOs by self-identified gender., Methods: Based on a national CATI survey weighted to population norms, 11,560 respondents reported whether they had been personally and negatively affected by another person's gambling in the past 12 months; and if so, answered detailed questions about the harms experienced from the person's gambling who had harmed them the most., Results: Past-year prevalence of gambling-related harm to adult Australian CSOs was (6.0%; 95% CI 5.6%-6.5%). CSOs most commonly reported emotional harms, followed by relationship, financial, health and vocational harms, respectively. Former partners reported the most harm, followed by current partners, other family members and non-family members, respectively. Female CSOs were more likely to report more harm and being harmed by a partner or other family member, and male CSOs from a non-family member., Discussion and Conclusions: The findings provide new insights into the wider societal burden of gambling and inform measures aimed at reducing harm to CSOs from gambling and supporting them to seek help.

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services., (© 2022 World Psychiatric Association.)