Epidemiological Challenges in the Study of Behavioral Addictions: a Call for High Standard Methodologies
Purpose of Review
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes gambling disorder in the section on substance-related and addictive disorders, and the 11th revision of the International Classification of Diseases (ICD-11) includes both gambling and gaming disorder as disorders due to addictive behaviors. However, there is less evidence for other putative behavioral addictions. This review focuses on requirements for epidemiological studies of disorders that may be considered as behavioral addictions and compares the current state of research with principles of sound epidemiological research.
In studies of behavioral addictions, samples are often quite small, which may lead to increased random error. The lack of sound assessment tools—particularly the lack of agreed-upon diagnostic criteria and standardized diagnostic interviews—may also increase systematic error. Other concerns related to systematic bias include the use of convenience samples, lack of pro-active recruitment, inadequate assessment of confounding variables, and a dearth of representative and longitudinal studies.
This review recommends that future studies of putative behavioral addictions should more closely adhere to methodological standards of epidemiological research to reduce random and systematic error. Specific recommendations are detailed to advance epidemiological research in this area with the aim of improving the evidence base and generating more refined public health recommendations and policies.
KeywordsBehavioral addiction Epidemiology Surveys Assessment Recommendation Random error Systematic error
Vladimir Poznyak is a staff member of the World Health Organization. The views expressed in this publication do not necessarily represent the decisions or policies of the World Health Organization.
This publication is based upon work from COST Action CA16207 “European Network for Problematic Usage of the Internet,” supported by COST (European Cooperation in Science and Technology: www.cost.eu). Marc Potenza has received support from the Connecticut State Department of Mental Health and Addiction Services, the Connecticut Mental Health Center, the Connecticut Council on Problem Gambling, and the National Center for Responsible Gaming. The funding agencies did not provide input or comment on the content of the manuscript, and the content of the manuscript reflects the contributions and thoughts of the authors and do not necessarily reflect the views of the funding agencies. Zsolt Demetrovics was supported by the Hungarian National Research, Development and Innovation Office (Grant No.: KKP126835).
Compliance with Ethical Standards
Conflict of Interest
Hans-Jürgen Rumpf, Dominique Brandt, Zsolt Demetrovics, Joël Billieux, Natacha Carragher, Matthias Brand, Henrietta Bowden-Jones, Afarin Rahimi-Movaghar, Sawitri Assanangkornchai, Renata Glavak-Tkalic, Guilherme Borges, Hae-Kook Lee, Florian Rehbein, Naomi A. Fineberg, Karl Mann, Marc N. Potenza, Dan J. Stein, Susumu Higuchi, Daniel King, John B. Saunders, and Vladimir Poznyak declare that they have no conflict of interest with regard to this manuscript.
Naomi Fineberg reports personal fees from Otsuka, Lundbeck, Abbott, Sun Pharma, Taylor and Francis, Elsevier; personal fees and non-financial support from RANZCP, Wiley; grants from NIHR, Wellcome; grants and non-financial support from EU, ECNP, Shire; non-financial support from BAP, WHO, CINP, ISAD, RCPsych, International College Of OC Spectrum Disorders, IFMAD, MHRA; and others from Oxford University Press, all outside the submitted work.
Marc Potenza has received financial support or compensation for the following: Dr. Potenza has consulted for and advised RiverMend Health, Opiant/Lakelight Therapeutics, and Jazz Pharmaceuticals; has received unrestricted research support from Mohegan Sun Casino and grant support from the National Center for Responsible Gaming; and has consulted for legal and gambling entities on issues related to impulse control disorders.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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