Immune to addiction: the ethical dimensions of vaccines against substance abuse.

Promising advances have been made in recent years for a unique class of immunotherapies that use vaccination to combat substance-use disorders. Although such vaccines are potentially useful for addictions, they raise a variety of ethical and social questions.

App-Based Addiction Prevention at German Vocational Schools: Implementation and Reach for a Cluster-Randomized Controlled Trial.

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program "ready4life." A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups. The trial was registered in the German Clinical Trials Register (DRKS): DRKS00022328; registration date 09.10.2020.

Exploring the Impact of Safer Sports Betting Promotion on Social Media: An Experimental Study.

The current study assessed the effectiveness of delivering safer gambling messaging to regular sport bettors on social media. It also assessed whether the content of the message impacted message effectiveness. A 3 × 2 mixed factorial design was employed, with 281 participants randomly assigned to follow one of three Twitter accounts. The accounts either sent out informational messages, self-appraisal messages or emotional self-efficacy messages. Participants reported betting behaviour from the two weeks prior to following the accounts, in addition to during the two-week intervention period, using information from their online gambling accounts. Participants reported readiness to change gambling behaviour pre and post the two-week intervention period. A significant main effect of intervention stage highlighted reductions in betting behaviour and increased readiness to change behaviour. However, there was no significant main effect of condition and no significant interaction between intervention stage and condition upon betting behaviour or readiness to change. The findings suggest receiving safer gambling messages on social media may lead to a reduction in betting behaviour. However, similar reductions in behaviour were observed in the experimental and control conditions. Further research is needed to clarify whether changes in behaviour observed in the current study would extend over a longer period of time.

Students as teachers: effect of the peer education model on reducing smartphone addiction in adolescents.

The group at the highest risk of smartphone addiction is adolescents. In particular during the coronavirus disease 2019 pandemic, factors such as conducting education online, curfew and the increase in the monotonous time spent at home have led to an increase in the use of smartphones among adolescents. Therefore, this study aimed to determine the effect of the peer education model on reducing smartphone addiction in adolescents. The present semi-experimental study with a pre-test-post-test control group was carried out with 622 high school students in Turkey. The study was carried out between September 2021 and February 2022 in two stages. In the first stage, the peer educator education program on smartphone addiction in adolescents was implemented. In the second stage, the peer education program was implemented and monitored. While there was no significant difference between the intervention and control groups in terms of the mean scores they obtained from the Smartphone Addiction Scale at the pre-test (P > 0.05), the difference between them was statistically significant at the post-test (P < 0.001). This study demonstrated that the peer education model was effective in reducing smartphone addiction in adolescents. Thus, it can be recommended that school-based peer education programs for adolescents should be prepared and implemented.

Self-exclusion and breaching of self-exclusion from gambling: a repeated survey study on the development of a nationwide self-exclusion service.

BACKGROUND: Voluntary self-exclusion from gambling is a common harm reduction tool in individuals with a gambling disorder. Previous data have demonstrated that many gamblers breach their own self-exclusion, typically through other online services outside the jurisdiction in which they are self-excluded. The present study aimed to carry out a new follow-up measure-similar to previous studies in the same setting-of self-exclusion and its breaching in Sweden, in order to allow for the follow-up assessment of a nationwide, multi-operator self-exclusion system introduced in Sweden in 2019. METHODS: A web survey to the web panel of a market survey company addressed 1505 past-year gamblers, who responded to a number of questions about gambling habits, including screening for gambling problems using the Problem Gambling Severity Index and self-exclusion-related items corresponding to previous studies. RESULTS: Nine percent of past-year gamblers had self-excluded using the Spelpaus service. In logistic regression, self-exclusion was significantly associated with gambling problems, past-year online casino gambling, and absence of online poker gambling. Among self-excluders, 49 percent had ever gambled despite being self-excluded. Among those breaching their self-exclusion, the most common gambling types during self-exclusion were online casino (82 percent), sports betting (47 percent) and lotteries (43 percent). DISCUSSION: Self-exclusion remains a popular harm reduction tool against problem gambling, more common than in previous studies, mostly in individuals with recent gambling problems and in online casino gamblers. However, breaching self-exclusion is somewhat more common than in previous research. Online casino represents the most common means of self-exclusion breaching. Policy-making in the area needs to further address the risk of breaching one's self-exclusion and may further address the risk of overseas gambling.

The effect of gamification-based training on the knowledge, attitudes, and academic achievement of male adolescents in preventing substance and internet addiction.

BACKGROUND: Preventing addiction through training takes precedence over treatment and plays a crucial role in enhancing the well-being of adolescents. Utilizing inclusive and participatory methods can significantly enhance the effectiveness of education. Numerous studies have demonstrated that gamification, as an interactive and comprehensive approach, has the potential to boost teenagers' motivation to engage in learning and contributes to better comprehension. AIM: This study aimed to assess the impact of gamification-based training to prevent substance and internet addiction on the knowledge and attitudes of male adolescents. Additionally, the study examined this educational program's effects on male adolescents' academic achievement. METHODS: This study employed a quasi-experimental design with a control group. One hundred fourteen male adolescents were randomly assigned to the intervention or control groups. They completed a pre-intervention questionnaire assessing addiction-related knowledge, attitudes, and academic achievement. Subsequently, the intervention group received the gamification-based drug and internet addiction prevention training. Post-tests were conducted immediately after the training and again one month later for both groups. RESULTS: Before the intervention, there were no significant differences in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement between the intervention and control groups (P > 0.05). However, after the intervention, the intervention group demonstrated significantly higher scores in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement compared to the control group (P < 0.001). CONCLUSION: The current study highlights the positive impact of gamification-based training on enhancing male adolescents' knowledge, attitudes, and academic achievement.

Effect of solution-focused approach on problematic internet use, health behaviors in schoolchildren.

BACKGROUND: Problematic internet use negatively affects adolescents' health behaviors and school success. PURPOSE: This study evaluated the effects of a solution-focused approach (SFA) on adolescents' problematic internet use, health behaviors, and perceived academic success. METHODS: A randomized controlled experimental design was used with pre-test-post-test. The sample comprised 128 middle school students, with 64 in the intervention group and 64 in the control group. Data were collected using an information form, Young's Internet Addiction Test, the Nutrition-Exercise Behavior Scale, and the Nutrition-Exercise Attitude Scale. The intervention group attended six SFA group meetings. RESULTS: "The intervention group's, mean pre- and post-test internet addiction scores were 35.65 ± 4.43 and 17.07 ± 5.01, respectively. There were statistically significant differences between the post test groups (p < 0.05) for mean internet addiction, total nutrition-exercise attitude, and total nutrition-exercise behavior and subdimension (except regular meals) scores and perceived academic success. IMPLICATIONS FOR PRACTICE AND RESEARCH: SFA may prevent students' uncontrolled internet use, help them gain positive health behaviors, and increase perceived academic success. The school nurse, on the other hand, may support the adolescent and their families with solution-focused interview strategies.

Ludens: A Gambling Addiction Prevention Program Based on the Principles of Ethical Gambling.

Gambling is legal in most countries. However, despite having some economic benefits, certain characteristics of gambling can have health consequences, rendering it a public health issue. The effects can be summarized according to the following three "laws" of ethical gambling: "Gambling Dynamics Law": companies' economic gains come directly from players' losses; "Expected Loss Law": the more one gambles, the greater the probability of losing; and "Addiction Law": the more one gambles, the greater the need to play again, leading to further losses. Ludens is a gambling addiction prevention program that has four goals: inform participants about gambling and gambling addiction; sensitize participants to the risk of gambling for health, especially addiction; promote a change in attitudes toward gambling; and alert participants to risky behaviors that can lead to addiction. The prevention program was implemented during 2017 to 2019. Fourteen psychologists presented it to 2372 adolescents (48.8% females, 51.2% males) aged 14-19 years, none of whom were university students, recruited from 42 Spanish high schools in 132 groups taking different courses. The main dependent variables analyzed were the monthly frequencies of gambling, at-risk gambling, and gambling addiction (as measured by the National Opinion Research Center DSM-IV Screen for Gambling Problems, adapted to diagnose gambling disorder according to DSM-5, in which pathological gambling is considered an addictive disorder). Given that all of the gamblers were adolescents (most were minors), fulfilment of 1-3 the DSM-5 diagnostic criteria was considered to indicate a risk of problem gambling. After the administration of Ludens, statistically significant reductions were observed in the three variables of interest: monthly frequency of gambling, percentage of adolescents with risky gambling, and percentage of adolescents with gambling disorder. The results were analyzed according to sex and age (minors vs. adolescents between 18 and 19 years old). The results obtained after applying the prevention program indicate that Ludens is effective as a universal prevention program for gambling addiction.

A grounded theory study to explore the digital gameplay experiences of adolescents at risk of addiction in Turkey.

PURPOSE: This study aimed to explore the experiences of adolescents at risk of digital game addiction in Turkey. DESIGN AND METHODS: Guided by a grounded theory design, data were collected from 14 adolescents through one-on-one in-depth interviews between January and April 2021. Simultaneous data collection and analysis involved theoretical sampling, constant comparison, and memo writing. Open, axial, and selective coding were used in data analysis, while analytic coding identified the core category and subcategories and provided the foundation for the substantive theory. RESULTS: The core category, "I want to limit my time playing digital games, but I need the support of my family to do so," demonstrated the adolescents' awareness of their situation. The analysis yielded an interpretive theory comprising three inter-related categories: causal factors, effects on life, and solution pathways. CONCLUSIONS: The participants' reasons for playing digital games included meeting their need for socialization and passing the time. However, digital gaming affects adolescents physically, psychosocially, and culturally. Solutions include early childhood education and family support, which can significantly reduce the risk of digital game addiction. PRACTICE IMPLICATIONS: Preventing digital game addiction is an important goal, and identifying risks contributing to digital game addiction is fundamental to establishing preventive measures. This study's findings may increase awareness of the subject for teachers, school nurses, and parents. Among the potential remedial measures are future studies focused on preventing digital game addiction and adding instruction to school curricula regarding necessary and beneficial uses of digital technologies.

The effect of peer relationship enhancement programs on the prevention of smartphone addiction among late school-age children in South Korea.

PURPOSE: This study investigated the effectiveness of a peer relationship enhancement program in preventing smartphone addiction among late school-age children. DESIGN AND METHODS: This study employed a non-equivalent control pretest-posttest design. The participants (the experimental and control groups comprised 27 and 25 participants, respectively) included late school-age children who were registered at eight community children's centers in a region in South Korea. The program comprised group-based play and art activities, spanning 12 sessions, each of which was 90 min long. The outcome variables were peer relationships, depression, self-control, and smartphone addiction. Data were collected through baseline, post-intervention, and follow-up assessments and analyzed through repeated measures analysis of variance (RM-ANOVA). RESULTS: This program had a significant effect on peer relationships, depression, and smartphone addiction; however, no effect was found on self-control. CONCLUSION: The peer relationship enhancement program of this study was effective in preventing smartphone addiction by improving peer relationships and reducing depression in late school-age children. PRACTICAL IMPLICATIONS: The peer relationship enhancement program can be utilized in various pediatric nursing settings to prevent smartphone addiction. Therefore, it contributes to the expansion of the field of pediatric nursing practices.

[Recommendations for the prevention, diagnosis, and therapy of addiction in the elderly]. / Recommandations pour la prévention, le diagnostic et la thérapie des addictions à l'âge avancé.

In old age, the chronic use of substances such as alcohol and sedatives, and more recently opioids, is a major public health and personal problem. Despite this, relatively little attention has been paid to the disorders associated with the use of these substances. These recommendations have been formulated by the Swiss Society for Elderly Psychiatry and Psychotherapy (SPPA) in collaboration with the Swiss Nurses' Association (SNA) and the Swiss Society for Addiction Medicine (SSAM). They provide a summary of the knowledge about addiction disorders in old age for the benefit of those working with patients, with the aim of strengthening prevention, early detection and appropriate interventions.

À l'âge avancé, la consommation chronique de substances comme l'alcool et les sédatifs, et plus récemment les opioïdes, représente un important problème pour les personnes concernées et de santé publique. Malgré cela, relativement peu d'attention a été accordée aux troubles associés à la consommation de ces substances. Les présentes recommandations ont été formulées par la Société suisse de psychiatrie et psychothérapie de la personne âgée (SPPA) en collaboration avec l'Association suisse des infirmières et infirmiers (ASI) et la Société suisse de médecine de l'addiction (SSMA). Elles mettent à la disposition des intervenants auprès des patients un résumé des connaissances au sujet des troubles addictifs à l'âge avancé, avec comme objectif de renforcer la prévention et le dépistage précoce, et des interventions adaptées.

[Mindfulness as a prevention tool in addiction]. / La pleine conscience comme outil de prévention en addictologie.

The development of psychosocial skills in children is considered an important element in the promotion of health and well-being. Mindfulness meditation in schools is a promising start in managing emotions and preventing addictions. A report from an addiction nurse on the experience of children in the fourth and fifth grades.

Testing Augmented Reality for Eliciting Cue-Provoked Urges to Smoke: Toward Moving Cue-Exposure Into the Real World.

BACKGROUND: Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (ie, cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy. OBJECTIVES: To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues. METHODS: A 2 × 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue. RESULTS: Average urge to smoke was higher following smoking-related AR images (Median = 7.50) than neutral images (Median = 3.33) (Z = -3.44; p = .001; d = 1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median = 8.12) were higher than for neutral cues (Median = 2.12) (Z = -3.44; p = .001; d = 1.64). Also, greater CR was observed for in vivo cues than for AR cues (Z = -2.67, p = .008; d = .36). AR cues were generally perceived as being realistic and well-integrated. CONCLUSIONS: CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy. IMPLICATIONS: This study introduces AR as a novel modality for presenting smoking-related stimuli to provoke cue reactivity, and ultimately to conduct extinction-based therapy. AR cues presented via a smartphone have the advantage over other modes of cue presentation (pictures, virtual reality, in vivo, etc.) of being easily transportable, affordable, and realistic, and they can be inserted in a smokers' natural environment rather than being limited to laboratory and clinic settings. These AR features may overcome the generalizability barriers of other methods, thus increasing clinical utility for cue exposure therapies.

The efficacy of a targeted PREVENTION programme for addictive behaviour (PREVENTURE) among vulnerable ADOlescents in France - study procotol.

BACKGROUND: Alcohol use is a major public health challenge in France, where at the age of 17 half the young people report an episode of severe alcohol intoxication in the month preceding the survey. Numerous prevention programmes have a general objective, but in adolescence individual vulnerabilities towards addictions differ significantly with personality traits. Prevention targeting personality traits enables work on risk factors for addictive behaviours, and has shown genuine efficacy. Among existing programmes, PREVENTURE has shown an effect on the reduction in alcohol consumption by targeting four personality traits: impulsivity, sensation-seeking, negative thoughts and anxiety. This programme has been tested on samples recruited in adolescent populations in school environments, identifying adolescents at risk, but it has not been tested on a more targeted recruitment of adolescents seen in consultation. METHODS: The main hypothesis of this study is that the targeted prevention programme PREVENTURE will have an impact on the prevalence of binge-drinking episodes. The secondary hypotheses explore other factors such as associated substance use, anxiety and depression, as well as the acceptability of the programme. This article presents the study protocol of "PREVADO" study. We intend to assess the impact of the targeted intervention programme PREVENTURE on the prevalence of binge-drinking episodes among adolescents aged 14 to 17 years consulting in one of the participating centres or referred by a school doctor. The study will be prospective, randomised, controlled and open-label, and will comprise an intervention group and a control group. The adolescents will then be followed and assessed 1, 3, 6 and 12 months after the intervention. The study needs to include 700 subjects in order to reach 340 adolescents randomised, 170 in each group. It will concern 33 centres. DISCUSSION: This project could favour the targeting of addictive behaviours among vulnerable adolescents, and its application on a larger scale could be envisaged. TRIAL REGISTRATION: The Trial registration number is NCT04599270 , and it was registered on the ClinicalTrials.gov public website.

Reaching Out to Big Losers: How Different Types of Gamblers are Affected by a Brief Motivational Contact Initiated by the Gambling Provider.

Telephone and letter-based motivational interventions with high expenditure gamblers have significant short and long term positive effects on gambling and use of responsible gambling tools. This report examines how different subtypes of gamblers, based upon patterns of play, are differentially affected. A randomized controlled trial design with three conditions (n = 1003 in each): feedback intervention by letter, telephone or a no-contact control condition. Subtypes of gamblers were derived by latent class analyses (LCA) based upon gambling behavior pre intervention. The participants were customers of Norsk Tipping gambling platforms. 1003 statistical triplets from the top 0.5% of customers based upon annual expenditure, matched on sex, age, and net losses. Primary outcome measure was gambling theoretical loss (TL), derived from the Norsk Tipping customer database. The LCA identified six subtypes: High Casino, High Sport, High Lottery, High Video lottery terminal (VLT), Lottery/Mix and Bingo/Casino. There were almost no differences in change in TL between the six subtypes of gamblers receiving the letter or telefone interventions respectively. However, the choice of contact by letter or telephone did have different effects for the different gambling subtypes. Sending a letter seems like a cost effective alternative to telephone contact for the High Lottery type, but telephone contact performs better for High Casino, High Sport and High VLT customers. Responsible gambling interventions can be improved by subtyping of gamblers.

Policy Responses to the Addiction Crisis.

The COVID-19 pandemic is just one of two public health crises the new Biden administration will confront. The addiction crisis is the other. The opioid epidemic has already killed more Americans than World Wars I and II combined. And it is but the most visible sign of a broader population health challenge that includes methamphetamine, cocaine, benzodiazepines, and alcohol. This article presents practical legislative and executive actions that are required for addressing these challenges. The authors focus on two broad policy challenges: (1) improving financing and delivery of treatment for substance use disorders, and (2) reducing population exposure to addictive and lethal substances. Through both of these channels, a portfolio of well-implemented, evidence-informed policies can save many thousands of lives every year.

Oxytocin and Addiction: Potential Glutamatergic Mechanisms.

Recently, oxytocin (OXT) has been investigated for its potential therapeutic role in addiction. OXT has been found to diminish various drug-seeking and drug-induced behaviors. Although its behavioral effects are well-established, there is not much consensus on how this neuropeptide exerts its effects. Previous research has given thought to how dopamine (DA) may be involved in oxytocinergic mechanisms, but there has not been as strong of a focus on the role that glutamate (Glu) has. The glutamatergic system is critical for the processing of rewards and the disruption of glutamatergic projections produces the behaviors seen in drug addicts. We introduce the idea that OXT has direct effects on Glu transmission within the reward processing pathway. Thus, OXT may reduce addictive behaviors by restoring abnormal drug-induced changes in the glutamatergic system and in its interactions with other neurotransmitters. This review offers insight into the mechanisms through which a potentially viable therapeutic target, OXT, could be used to reduce addiction-related behaviors.

[Alcohol prevention in the workplace: current workplace concepts for addiction prevention and addiction assistance programmes]. / Alkoholprävention am Arbeitsplatz: Aktuelle Konzepte zur betrieblichen Suchtprävention und Suchthilfe.

The standard workplace addiction prevention and addiction counselling programmes for preventing alcohol problems in the workplace and helping those at risk of addiction have been proven to be successful. The key elements are, firstly, information and education; secondly, early intervention if conspicuous behaviour in the workplace is identified; thirdly, qualification and counselling by human resources staff; and, finally, assistance for employees with alcohol or other substance addiction problems.In the 1970s, corporate addiction prevention programs based on the American model were established in Germany. In 2006 the German Centre for Addiction Issues (DHS) published for the first time the "Guidelines on Addiction Prevention and Assistance Programs in Companies" as a quality standard. Since then, all companies or public administrations have had open access to specialised knowledge and current legal materials. This is important in order to regulate and reduce alcohol consumption in the workplace. The prevention mandate of managers includes instructing employees on how to avoid health hazards. As soon as there are occupational safety violations, superiors are obliged to intervene. In general, they should intervene as early as possible in the case of irregularities caused by alcohol consumption. In the case of high-risk drug use and risk of addiction, the procedure is based on a tiered sequence of interviews. Support offers from internal or external advice centres are recommended.Alcohol and addiction prevention is part of occupational health management. It has a particularly lasting effect where the program has been written in a company or service agreement and is implemented in a binding manner.

Debate: Behavioural addictions and technology use - risk and policy recommendations for problematic online gambling and gaming.

Digital technology allows people to connect and share similar interests across geographical and temporal borders. Two behavioural disorders related to Internet use have been officially recognised as mental health disorders: Gambling Disorder by the American Psychiatric Association and Gaming Disorder by the World Health Organization. The prevalence estimates and risk indicators of developing problems associated with excessive technology use differ considerably across countries. Individual, structural and situational factors need to be taken into consideration when evaluating existing study outcomes. Based on the current evidence base regarding prevention of problematic technology use including gaming and online gambling and reducing harm, whilst paying attention not to overpathologise everyday behaviours, we recommend a multi-stakeholder approach, engaging researchers, clinicians, regulators and government bodies, community organisations and the industry. Implications for clinical practice include engaging in dialogue across experts and using evidence-based treatment approaches to support those in need of professional help.

[Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study]. / Überprüfung der Effekte dissonanzbasierter Primärprävention von Internet- und Computerspielabhängigkeit in der Jahrgangsstufe 5 auf die Einstellung zum Gaming: Eine Pilotstudie.

Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study Abstract. Objective: To date, childhood has hardly been considered in the development of effective prevention and intervention programs for gaming disorder and Internet addiction. PROTECTdissonance was therefore designed as a 1-hour dissonance-based, universal primary prevention program for grade 5 high-school students. This pilot study examines the immediate effects of dissonance induction on attitudes toward gaming. Method: A single-arm A+B design with three measurement points (T0, T1, T2) assessed attitudes toward gaming using the Gaming Attitude Test (GAT). The baseline sequence (sequence A, T0 to T1, subsample) included N = 83 high-school students (age: M = 10.27; SD = 0.48) and the intervention sequence (sequence B, T1 to T2, total sample) included N = 200 pupils (age: M = 10.24; SD = 0.47). Acceptance and satisfaction were recorded after the intervention. Results: Hierarchical linear growth models showed a significant reduction of GAT symptoms through the intervention, both in the total GAT score and on the subscale "Trivialization of Negative Consequences." There were no changes in the natural course (baseline sequence A). Pupils correspondingly reported a high rate of satisfaction with PROTECTdissonance. Conclusions: A brief, targeted dissonance-induction exercise shows immediate effects on an attitudinal measure of gaming. To follow up on this promising approach, future studies should investigate whether reduced trivialization of negative consequences of gaming is actually reflected in behavioral change.