Psychology of Addictive Behaviors

Public Perceptions of Behavioral and Substance Addictions

Brent Lang and Harold Rosenberg
Online First Publication, November 28, 2016. http://dx.doi.org/10.1037/adb0000228

CITATION
Lang, B., & Rosenberg, H. (2016, November 28). Public Perceptions of Behavioral and Substance
Addictions. Psychology of Addictive Behaviors. Advance online publication. http://
dx.doi.org/10.1037/adb0000228
 Psychology of Addictive Behaviors © 2016 American Psychological Association
2016, Vol. 30, No. 7, 000 0893-164X/16/$12.00 http://dx.doi.org/10.1037/adb0000228

BRIEF REPORT

Public Perceptions of Behavioral and Substance Addictions

Brent Lang and Harold Rosenberg
Bowling Green State University

Most of the research on public perceptions of people with addictive disorders has focused on alcohol and
illicit drugs, rather than addiction to behavioral activities. To expand the range of addictive behaviors
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

and types of perceptions studied, we designed the present study to assess the lay public’s definitions of
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and willingness to affiliate with people described as addicted to 1 of 2 specific behaviors (i.e.,
pornography or gambling) or 1 of 3 specific substances (i.e., alcohol, marijuana, or heroin). A nationwide
convenience sample (N ⫽ 612) of American adults completed online questionnaires during the summer
of 2015. Participants rated heroin as more addictive than the other drugs and behaviors and, despite
differences among the conditions, were generally unwilling to affiliate with an individual addicted to any
of the 2 behaviors or 3 substances. When asked to rate different potential indications of addiction,
participants endorsed behavioral signs of impaired control and physiological and psychological depen-
dence as more indicative of all 5 types of addiction than desire to use the substance or engage in the
addictive behavior. Despite recent efforts to increase public knowledge about addictive disorders,
members of the public continue to endorse some attitudes indicative of stigmatization toward people with
selected substance and behavioral addictions.

Keywords: stigma, behavioral addiction, substance addiction, definitions of addiction

Stigmatization refers to prejudicial attitudes and discriminatory
behaviors based primarily or exclusively on someone having a
negative characteristic (stigma), such as the diagnosis of a psychi-
atric disorder (Corrigan, 2004; Crisp, Gelder, Rix, Meltzer, &
Rowlands, 2000; Pescosolido et al., 2010). Of all the mental
illnesses, the public expresses particularly negative views of those
with alcohol and drug abuse (Crisp et al., 2000; Pescosolido et al.,
2010; Schomerus et al. (2011). One common method of assessing
stigmatization is to ask participants their level of preferred social
distance from or willingness to affiliate with an individual with
specific psychiatric disorders, including addictive disorders (e.g.,
Pescosolido et al., 2010).
Another means of evaluating public perceptions of substance
abuse disorders is to assess how people define addiction to drugs.
For example, Chassin, Presson, Rose, and Sherman (2007) asked
teenagers and their parents to rate how much they agreed with 13
specific behaviors that could be indicative of an addiction to
cigarettes. Based on factor analyses, Chassin et al. (2007) con-
cluded that those behaviors, some of which are similar to the
current Diagnostic and Statistical Manual of Mental Disorders
Brent Lang and Harold Rosenberg, Department of Psychology, Bowling
Green State University.
The results of this article have not been published or submitted to
another academic journal and have not been presented at an academic
conference.
Correspondence concerning this article should be addressed to Brent
Lang, Department of Psychology, Bowling Green State University, 822
East Merry Avenue, Bowling Green, OH 43403. E-mail: brentl@bgsu.edu
(5th ed.; DSM–5) criteria for a substance use disorder (American
Psychiatric Association [APA], 2013), comprised two subscales
representing “Appetitive” and “Compulsive” aspects of addiction.
The Appetitive subscale included behaviors reflecting desire to
smoke and continued use of tobacco despite negative conse-
quences. The Compulsive subscale reflected themes of impaired
control and physiological and psychological dependence. Adults in
the Chassin et al. (2007) sample rated Compulsive aspects as more
important than the Appetitive aspects in defining tobacco addic-
tion, whereas adolescents rated both aspects as equally important.
Most of the research on public perceptions of addiction has
focused on addiction to alcohol and illicit drugs rather than addic-
tion to behavioral activities. One exception is a study by Konkolÿ
Thege et al. (2015), who recruited a nationwide sample of Cana-
dians to assess individuals’ beliefs about the etiology, addiction
liability, and prevalence of specific substance addictions (i.e.,
alcohol, tobacco, marijuana, or cocaine) and specific “behavioral
addictions” (i.e., problematic gambling, eating, shopping, sexual
behavior, video gaming, or work). Participants reported that en-
gaging in any of the listed behaviors was less likely to result in
addiction than using any of the listed substances.
These previous investigations provide valuable information
about public perceptions of addictions. However, our review of the
literature revealed no previous publications that evaluated whether
participants’ definitions of addiction and willingness to affiliate
with people differed as a function of the specific substance or
behavior to which they were addicted. Therefore, we used a
between-subjects design to assess lay people’s views regarding
persons described as being addicted to either gambling, pornogra-
phy, alcohol, marijuana, or heroin.

1
 2 LANG AND ROSENBERG
We selected gambling as one of the two behavioral addictions
because DSM–5 includes it as an addictive disorder characterized
by symptoms of preoccupation with gambling, impaired control
(e.g., multiple failed quit attempts, “chasing” losses), tolerance,
psychological withdrawal, lying about gambling, losing a job or
relationships, and borrowing money from others (APA, 2013). We
selected pornography as the other behavioral addiction based on
arguments that hypersexuality, including excessive use of pornog-
raphy, has several features (e.g., tolerance, cravings, impaired
control, negative psychosocial consequences) similar to substance
use disorders (e.g., Grant, Potenza, Weinstein, & Gorelick, 2010;
Kafka, 2010; Kor et al., 2013; Kraus, Voon, & Potenza, 2016).
Among the many choices for specific substances, we selected
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alcohol in part because of the ubiquity of its use and availability,
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the prevalence of alcohol use disorders in the United States, and its
comparability with previously conducted research that included
alcohol dependence as a target condition. We selected marijuana
because of the prevalence with which it is used (Substance Abuse
and Mental Health Services Administration [SAMHSA], 2014),
recent changes to state laws regarding both recreational and med-
ical use of marijuana (Hill, 2015), and because many addiction
experts rate marijuana as less harmful than alcohol and heroin
(Nutt, King, & Phillips, 2010). Lastly, we selected heroin as the
third target substance because, unlike alcohol and marijuana, use
of heroin is uniformly illegal in the United States and much less
prevalent than alcohol and marijuana, but often results in serious
negative health and social consequences (Borg, Kravets, & Kreek,
2009; SAMHSA, 2014; Soyka et al., 2012; Tetrault & O’Connor,
2009).
Using data collected from a sample of American adults, we
addressed three main research questions about public perceptions
of behavioral and substance addictions: (a) Did perceived addic-
tion potential, willingness to affiliate, and definition of addiction
differ as a function of gender and the specific substance or specific
behavior to which a person is addicted? (b) Was closeness of
previous contact with individuals with the target behavioral or
substance addiction associated with greater willingness to affiliate
with a target identified as having that same behavioral or substance
addiction? (c) Did participants rate Compulsive aspects as more
indicative of an addiction than Appetitive aspects for each of the
five target addictions?
Method
Participants and Procedure
Following approval of the study by our institutional review
board, we used the Amazon Mechanical Turk online subject pool
to recruit U.S. residents between the ages of 18 and 65 years.
Participants who completed the study had $1.00 deposited into
their Amazon account.
A total of 663 potential participants clicked on the survey link
and completed at least part of the measures. Of these respondents,
we excluded (a) 16 participants who failed either of two checks of
attention, (b) 13 participants who took significantly longer than
average (⬎2.5 SDs) to complete the survey, (c) 10 participants
who completed fewer than 90% of the questionnaire items, (d) 9
participants who endorsed mutually exclusive levels of contact
with an individual with the target behavioral or substance addic-
tion (e.g., “I have never observed a person that I was aware had a
gambling addiction” and “I have observed persons with a gam-
bling addiction on a frequent basis”), and (e) 3 participants who
did not answer the age question. The final sample for all analyses
comprised the remaining 612 participants.
As examination of Table 1 reveals, participants assigned to
the five conditions differed on only 2 of the 10 listed demo-
graphic characteristics. Chi-square analyses revealed signifi-
cant but relatively weak associations between experimental
condition and whether participants lived alone or with others,
␹2(8) ⫽ 19.4, p ⫽ .01, ␸ ⫽ .18, and whether participants
reported having the target addiction about which they com-
pleted the measures, ␹2(4) ⫽ 13.13, p ⫽ .01, ␸ ⫽ .15. All
regions of the United States were represented, with similar
proportions of participants in each condition located in the
northeastern, midwestern, southern, and western United States.
In comparison with U.S. population estimates of several demo-
graphic variables (U.S. Bureau of Labor Statistics, 2011; U.S.
Census Bureau, 2011a, 2011b, 2011c, 2012a, 2012b, 2012c),
our sample contained greater proportions of young (under age
44), White, employed, never-married, college-educated partic-
ipants who lived alone.
Potential participants were provided with a short description of
the study and a link to an external survey Website (Qualtrics.com),
where they could give their informed consent and confirm their
eligibility. Next, they were randomly assigned to one of the five
experimental conditions using a random number generator. The
same questionnaires were presented in the same order in each of
the five conditions, but wording varied to indicate the specific
addictive substance or behavior about which participants answered
the dependent measures.
Measures
Social Distance Scale for Substance Users. We adminis-
tered a modified version of the Social Distance Scale for
Substance Users (Brown, 2011). This seven-item measure asks
participants to rate how willing they would be to interact with
an individual with a substance use problem (e.g., “rent a room
in one’s home,” “work on the same job,” “have person as a
neighbor”) using a scale ranging from 1 (definitely willing) to 4
(definitely unwilling). Cronbach’s alphas in the present sample
ranged from 0.78 to 0.92 across the five experimental condi-
tions.
Level of Contact Report. We administered a modified ver-
sion of the Level of Contact Report (Holmes, Corrigan, Williams,
Canar, & Kubiak, 1999). This measure is a 12-item checklist of
varying levels of contact one might have had with an individual
with mental illness, ranging from least familiar (i.e., “I have never
observed a person that I was aware had [target condition]”) to most
familiar (i.e., “I have [target condition]”). Participants are asked to
check all levels of contact they have experienced with people
presenting with the target condition and are given a score based on
the most familiar level of contact they endorse. Holmes et al.
(1999) reported high interrater reliability of the rank ordering of
items (␳ ⫽ 0.83) by experts in severe mental illness.
Subjective Definitions of Addiction Scale. Developed by
Chassin et al. (2007), this questionnaire has participants rate the
extent to which they consider each of the 13 listed behaviors,
 BRIEF REPORT 3

Table 1
Demographic Characteristics of Participants in Each Condition

M (SD) or percentage of samplea,b

Gambling Pornography Alcohol Marijuana Heroin
Variable (n ⫽ 127) (n ⫽ 112) (n ⫽ 118) (n ⫽ 123) (n ⫽ 132) Chi-square/F test

Age (years) 36.4 (11.9) 33.5 (10.7) 34.4 (10.8) 32.8 (10.7) 34.3 (11.6) 1.8
18–44 74% 84% 84% 85% 83%
45 and older 26 16 16 15 17
Gender 2.0
Male 50% 51% 56% 47% 49%
Female 50 49 44 53 51
Region 16.3
Northeast 17% 20% 19% 18% 24%
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Midwest 21 29 23 21 17
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West 29 16 21 33 23
South 32 33 36 28 36
Ethnicity 5.9
White/Caucasian 81% 83% 76% 72% 82%
Non-White/Non-Caucasian 19 17 24 28 18
Employment status 13.3
Employed (full or part time) 72% 63% 70% 70% 72%
Unemployed 13 25 16 13 19
Other (student or retired) 15 9 11 16 8
Highest degree earned 13.5
High school (secondary school) degree or less 6% 18% 10% 7% 8%
Some college or college graduate 72 66 74 72 74
Graduate or professional degree 22 16 16 20 18
Relationship status 13.9
Never married 47% 55% 59% 65% 60%
Married 46 34 33 28 28
Widowed or divorced 7 9 9 7 11
With whom participants lived 19.4ⴱ
Alone 15% 24% 21% 21% 30%
With romantic partner/spouse 63 47 49 42 43
With others (e.g., parents or family, roommate) 21 27 30 37 27
Percentage of participants with target disorderc 2% 2% 7% 2% 0% 13.1ⴱ
Political orientationd 2.70 (1.16) 2.47 (1.15) 2.50 (1.13) 2.31 (1.17) 2.43 (1.19) 1.9
a
Percentages are based on the number responding to each question and may not add up to 100% due to rounding. b No more than three participants in
each condition declined to respond to any one item. c Based on participants’ endorsement of the statement, “I have [target addiction],” on the Level of
Contact Report. d Based on question about political orientation on 5-point scale ranging from 1 ⫽ liberal to 5 ⫽ conservative.
ⴱ
p ⬍ .05.

emotions, cognitions, and physiological reactions to be indicative
of addiction using a scale from 1 (not at all) to 5 (very much).
Exploratory and confirmatory factor analyses by Chassin et al.
(2007) identified two factors: (a) Appetitive aspects of addiction
and (b) Compulsive aspects of addiction. In the present sample,
Cronbach’s alphas for the Compulsive subscale ranged from 0.81
to 0.89 across the five conditions. After we removed the item
“Getting high” from the Appetitive subscale because it may not
apply to behavioral addictions, Cronbach’s alphas for this subscale
ranged from 0.71 to 0.88 across the five experimental conditions.
Correlations between the revised Appetitive subscale and Com-
pulsive subscale ranged from .24 to .51 across the five experimen-
tal conditions.
Perceptions of addiction potential. We used this one-item
measure from Konkolÿ Thege et al. (2015) to assess participants’
perceptions of how addictive (1 ⫽ not at all addictive to 5 ⫽
extremely addictive) the specified behavior or substance was for
most people.
Demographics questionnaire. We designed this question-
naire to assess age, gender, geographic location, ethnicity, employ-
ment and educational status, relationship and current living status,
and political orientation.
Social Desirability Scale (SDS). We administered a 16-item
version of the Social Desirability Scale—17 (Stöber, 2001), ex-
cluding the item asking about use of illegal drugs. Cronbach’s
alphas for the SDS-16 in the present sample ranged from 0.78 to
0.84 across the five experimental conditions.
Results
Preliminary Analyses
We calculated the correlations among the four outcome mea-
sures within each of the five experimental conditions. Because
only 2 of these 30 correlations exceeded r ⫽ .50, we considered
the four dependent measures as sufficiently independent to con-
duct a separate one-way analysis of variance (ANOVA) for each
dependent measure. To control for inflation of familywise error,
we used a Bonferroni correction for the ANOVAs (␣ ⫽ .0125;
.05/4) and post hoc pairwise tests. We also evaluated the associ-
 4 LANG AND ROSENBERG

ation between scores on the Social Desirability Scale and each of
the four dependent measures within each of the five experimental
conditions. None of the 20 bivariate correlations exceeded r ⫽ .50,
and we concluded that participants’ responses were not meaning-
fully associated with the tendency to present themselves in a
socially desirable manner.
How Addictive Did Participants Rate Behavioral and
Substance Addictions?
The 2 (gender) ⫻ 5 (condition) ANOVA revealed no signif-
icant interaction or main effect for participant gender. However,
there was a main effect of experimental condition on percep-
tions of addiction potential, F(4, 602) ⫽ 116.8, p⬍ .001, ␩2 ⫽
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pants were generally unwilling to affiliate with individuals with
any type of addiction (see Table 2).
Second, we calculated Pearson correlations, separately for
women and for men, to evaluate whether willingness to affiliate
was associated with past Level of Contact scores. Contrary to
our hypothesis, and regardless of participant gender, willing-
ness to affiliate was not significantly associated with previous
level of contact with people with each type of addiction (all
Pearson rs ⱕ .16).
How Did Participants Define Behavioral and
Substance Addictions?

The 2 (gender) ⫻ 5 (condition) ANOVA for the Compulsive

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.43, and the effect size was large in magnitude. As Table 2

shows, post hoc tests revealed that participants rated heroin as
significantly more addictive than the other two substances and
the two behaviors. Participants also rated alcohol as signifi-
cantly more addictive than pornography and marijuana, but not
significantly more addictive than gambling. However, except
for heroin, the means of the remaining four types of addiction
indicate that participants viewed those four as only Slightly
Addictive to Somewhat Addictive.
How Willing Were Participants to Affiliate
With Those Who Have Behavioral and
Substance Addictions?
The 2 (gender) ⫻ 5 (condition) ANOVA revealed a signifi-
cant interaction, F(4, 602) ⫽ 3.6, p ⫽ .007, ␩2 ⫽ .01, but the
effect size was small. As examination of Figure 1 reveals,
female participants were significantly less willing to affiliate
with someone with an addiction to pornography than were men,
but women and men were equally willing to affiliate with
people with the other four addictions. More meaningfully, there
was a main effect of experimental condition, F(4, 602) ⫽ 31.7,
p ⬍ .001, ␩2 ⫽ .17, and the effect size was large. Post hoc tests
for the condition means revealed that participants were signif-
icantly less willing to affiliate with individuals with heroin
addiction than with the other four addictions; participants were
also less willing to affiliate with individuals with alcohol ad-
diction than those with pornography or marijuana addiction.
Nevertheless, across all five experimental conditions, partici-
subscale revealed no significant interaction, but there was a
significant main effect of experimental condition, F(4, 602) ⫽
13.7, p ⬍ .001, ␩2 ⫽ .06, and the effect size was medium. As
shown in Table 2, post hoc tests revealed that participants
endorsed Compulsive aspects as stronger indicators of addiction
to heroin, alcohol, and gambling than to pornography and
marijuana, although they generally rated Compulsive aspects as
Pretty Much indicative of all five types of addiction. In addi-
tion, there was a significant main effect of participant gender on
Compulsive subscale scores, F(1, 602) ⫽ 4.9, p ⫽ .027, ␩2 ⫽
.01, but the effect size was small and women rated Compulsive
aspects as only slightly stronger indicators of addiction (M ⫽
4.4, SD ⫽ 0.6) than did male participants (M ⫽ 4.3, SD ⫽ 0.6).
For the revised Appetitive subscale, there was no significant
interaction or significant main effect for participant gender.
There was a significant main effect of experimental condition,
F(4, 607) ⫽ 23.5, p ⬍ .001, ␩2 ⫽ .13, and the effect size was
medium to large. As shown in Table 2, participants endorsed
Appetitive aspects as stronger indicators of addiction to heroin,
alcohol, and gambling than addiction to pornography and mar-
ijuana. However, participants rated Appetitive aspects between
Somewhat and Pretty Much indicative of all four types of
addiction except marijuana. Furthermore, paired-samples t tests
between the two subscales within each of the five experimental
conditions revealed that participants rated Compulsive aspects
as significantly more indicative of addiction than Appetitive
aspects for each of the five addictions (all ps ⬍ .001).

Table 2
Means (Standard Deviations), F Ratios, and Effect Sizes of Dependent Measures by Condition

M (SD)
Dependent measures Gambling Pornography Alcohol Marijuana Heroin F ratio ␩2

Addictive potential† 2.6 (1.0)a,b 2.4 (1.0)b 2.8 (1.0)a 2.2 (1.1)b 4.5 (.6)c 116.8ⴱⴱ .43
Willingness to affiliate‡ 3.0 (.5)b,d 2.9 (.6)b 3.1 (.6)d 2.9 (.7)b 3.5 (.4)c 31.7ⴱⴱ .17
Compulsive subscale§ 4.4 (.5)a 4.1 (.8)b 4.4 (.6)a 4.1 (.6)b 4.6 (.4)a 13.7ⴱⴱ .06
Appetitive subscale§ 3.6 (.9)a,c 3.0 (1.1)b 3.5 (.9)c 2.7 (1.1)b 3.8 (1.0)a 23.5ⴱⴱ .13
Note. Means with different superscript letters after standard deviations indicate that pairwise post hoc tests were significantly different p ⬍ .05.
†
Based on the question, “How addictive is [target behavior or substance] for most people?” rated on 5-point scale ranging from 1 ⫽ not at all addictive
to 5 ⫽ extremely addictive. ‡ Based on Brown’s (2011) Social Distance Scale rated on 4-point scale ranging from 1 ⫽ definitely willing to 4 ⫽ definitely
unwilling. § Based on Chassin et al.’s (2007) Subjective Definitions of Addiction subscales, each of which rated on 5-point scale ranging from 1 ⫽ not
at all to 5 ⫽ very much. ⴱⴱ p ⬍ .01.
 BRIEF REPORT
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Figure 1. Willingness to affiliate by gender and addiction type. Based on the four- point Social Distance Scale
from 1 (definitely willing) to 4 (definitely unwilling). Error bars indicate 95% confidence intervals. ⴱ p ⫽ .003.
Discussion
A large nationwide sample of the lay public was less willing to
affiliate with those described as having an alcohol, heroin, or gam-
bling addiction than those with a marijuana or pornography addiction.
Furthermore, women were less willing to affiliate with someone
addicted to pornography than were men. These differences notwith-
standing, and consistent with previous studies (e.g., Link et al., 1999;
Pescosolido et al., 2010; Schomerus et al., 2011), participants in the
present study were generally unwilling to affiliate with an individual
with any of these types of addiction. It appears that members of the
lay public remain unwilling to affiliate with those individuals who
experience an addiction. Whether new and different types of educa-
tional interventions (Thornicroft et al., 2016) can reduce stigmatiza-
tion, or whether people with substance addictions and behavioral
addictions will continue to be seen as unworthy of social acceptance,
warrants continued evaluation.
Contrary to previous research on other psychiatric conditions (Cor-
rigan et al., 2001; Holmes et al., 1999), past interaction with someone
with the target addiction was not significantly associated with partic-
ipants’ willingness to affiliate with an individual with that addictive
condition. It may be that familiarity is more relevant when the psy-
chiatric condition is depression, schizophrenia, or anxiety rather than
an addictive disorder. Also, level of familiarity per se may be less
important than whether those interactions have been positive, negative
or neutral.
Regarding definitions of addiction, women endorsed Compulsive
elements as indicative of addiction more strongly than did men, but
the effect size and absolute difference in means were notably small.
5
Consistent with Chassin et al.’s (2007) study of tobacco addiction, our
participants rated Compulsive elements as more indicative than Ap-
petitive elements, although both men and women generally agreed
with statements reflecting both Compulsive and Appetitive aspects of
addiction. This indicates that lay definitions of both substance and
behavioral addictions are consistent with the diagnostic criteria listed
in DSM–IV and DSM–5 (APA, 2013).
One major limitation of the present study is the representativeness
of our sample. In comparison to both the population of the United
States, and the nationally representative sample used by Pescosolido
et al. (2010), the present sample included larger proportions of White,
younger, and higher socioeconomic status individuals. This may have
been due to the use of online data recruitment and collection, which
limited participation to those with computer access and a Mechanical
Turk account. In comparison to older individuals, younger individuals
in the United States have presumably grown up in a culture with
increased tolerance of diversity, and tend to identify less with con-
servative ideology (Pew Research Center, 2014). Given that previous
research has found an association between conservative attitudes and
increased stigmatization (Furnham & Thomson, 1996), the present
results may underestimate how unwilling the overall American public
is to affiliate with those described as addicted to a variety of sub-
stances and behaviors.
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Received April 10, 2016
Revision received August 17, 2016
Accepted September 24, 2016 䡲