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Commentary: Suggesting Shinrin-Yoku (Forest Bathing) for Treating Addiction

July 2020
Addictive Behaviors 111

DOI:10.1016/j.addbeh.2020.106556

Authors:

Yasuhiro Kotera

University of Nottingham

Christine Rhodes

University of Derby

Shinrin-yoku ('') (i.e., forest bathing), a Japanese wellbeing practice, aims to harmonise a person with a forest by bathing in the forest mindfully using our five senses (Miyazaki, 2018). Practitioners can choose whatever they like to focus on in the forest: different colours of leaves, the sounds of streams, or the warmth of sunshine beaming between leaves. Since the birth of this practice in 1982, shinrin-yoku has been widely used in the Japanese clinical fields (Hansen, Jones, & Tocchini, 2017). Recently, this healing practice has received attention from healthcare practitioners and researchers worldwide (Wen, Yan, Pan, Gu, & Liu, 2019). In this commentary, we will discuss limitations of the current shinrin-yoku research, and how future research can be conducted to appraise the effects of shinrin-yoku on addiction.

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Commentary: Suggesting Shinrin-Yoku (Forest Bathing) for Treating Addiction

Yasuhiro Kotera, Christine Rhodes

Keywords

shinrin-yoku; forest bathing; nature therapy; addiction

Citation

Kotera, Y. & Rhodes, C. (2020). Commentary: Suggesting shinrin-yoku (forest bathing) for

treating addiction. Addictive Behaviors.

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Shinrin-yoku (‘森林浴’) (i.e., forest bathing), a Japanese wellbeing practice, aims to

harmonise a person with a forest by bathing in the forest mindfully using our five senses

(Miyazaki, 2018). Practitioners can choose whatever they like to focus on in the forest:

different colours of leaves, the sounds of streams, or the warmth of sunshine beaming

between leaves. Since the birth of this practice in 1982, shinrin-yoku has been widely used in

the Japanese clinical fields (Hansen, Jones & Tocchini, 2017). Recently, this healing practice

has received attention from healthcare practitioners and researchers worldwide (Wen, Yan,

Pan, Gu & Liu, 2019). In this commentary, we will discuss limitations of the current shinrin-

yoku research, and how future research can be conducted to appraise the effects of shinrin-

yoku on addiction.

Needs for cost-effective and accessible treatment for addiction

Shinrin-yoku is increasingly popular for a variety of reasons. It is free to use (though

there are a few forests that charge for entrance), relatively accessible, in line with today’s

global emphasis on environmental preservation, and effective for diverse health outcomes.

Physically, being immersed in a forest improves one’s immune system and the functions of

cardiovascular and respiratory systems (Williams, 2016). Psychologically, shinrin-yoku is

effective in treating mood disorders (e.g., depression and anxiety) and stress, enhancing

relaxation, gratitude and selflessness (Park, Tsunetsugu, Lee, Kagawa & Miyazaki, 2012;

Pritchard, Richardson, Sheffield & McEwan, 2019). The positive effects of shinrin-yoku on

mental health effects are particularly noteworthy as poor mental health is one of today’s

global challenges. For example, Goal 3 of the United Nations’ Sustainable Development

Goals refers to good wellbeing (United Nations, 2015). About 15% of the world population

(1.1 billion people) have a mental health or substance use disorder (Ritchie & Roser, 2018).

Mental health problems are understood to be one of the primary causes of all diseases in the

world (Vol et al., 2015), estimated to contribute to economic output losses of $2.5-8.5 trillion

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globally (Patel et al., 2018) with a forecast to increase to £6 trillion by 2030 (Marquez &

Saxena, 2016). At a country-level, the costs of mental disorders are about 3% of gross

domestic product (GDP) in developed countries (Hewlett, 2014), and substantially higher in

developing countries (Patel, 2007).

Among mental health disorders, one of the most prevalent is substance misuse,

affecting approximately 100 million people worldwide (Orford et al., 2013). Mortality rates

of substance misuse are not modest: 111 (tobacco) and 33 (alcohol) deaths per 100,000, and

numbers are rising (Peacock et al., 2018). Moreover, polysubstance users, who were recruited

at harm-reduction facilities and shelters, were associated with a ten times higher mortality

rate than the general population (Gjersing & Bretteville-Jensen, 2018). Because of the

complex nature of addiction, a single cause for addiction has not yet been identified, hence

the standardised effective treatment modality is unknown (Miller, 2019). As a result, in

clinical practice, diverse approaches are often used (e.g., medication, counselling, and

mutual-help groups), yielding extra costs. The treatment costs for addiction to the National

Health Service (NHS) in the United Kingdom are estimated to exceed £500 million annually

(National Drug Treatment Monitoring System, 2017), equating to 4% of the mental health

costs (12 billion; NHS, 2020). A significant contributing factor for this heightened cost is the

high number of relapse rates, ranging from 40% to 80% (National Institution on Drug Abuse,

2018), with 66% in the first six months, 35% after one year, and 19% during the first six

years (Frimpong, 2016). A cost-effective and accessible treatment is needed, and shinrin-

yoku could be one intervention to help people suffering from substance misuse and other

types of addiction.

Possible efficacy of shinrin-yoku on addiction to be researched

A recent systematic review and meta-analysis for the effects of shinrin-yoku on

mental health outcomes revealed that shinrin-yoku was effective for reducing depression,

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anxiety, anger and stress, and the effects on anxiety were the largest (Kotera, Richardson &

Sheffield, 2020). This suggests that shinrin-yoku could be an effective treatment for

addiction, because many types of addiction are associated with mental distress such as

anxiety, stress and depression. These include sex addiction (Kotera & Rhodes, 2019),

substance misuse (Smith & Book, 2008), gambling (Medeiros, Sampaio, Leppink,

Chamberlain & Grant, 2016; Rizeanu, 2013), internet addiction (Li, Hou, Yang, Jian &

Wang, 2019), social media addiction (Fabris, Marengo, Longobardi & Settanni, 2020),

exercise addiction (Lodovico, Poulnais & Gorwood, 2019), and eating disorders such as

compulsive overeating (Davis & Claridge, 1998). By alleviating mental distress including

anxiety, shinrin-yoku could improve recovery rates from addiction. In our analysis, only one

study (of twenty included studies) targeted substance misuse (alcohol) (Shin, Shin & Yeoun,

2012): a nine-day shinrin-yoku programme reduced alcoholics’ depression (medium-large

effect), while depression in the passive control group did not. Future studies should evaluate

whether shorter interventions would yield beneficial effects on addiction.

Additionally, the mechanism of how shinrin-yoku might work for addiction needs to

be appraised. There are several theories defining the mechanism of shinrin-yoku on

wellbeing. Attention Restoration Theory posits that spending time in nature recovers our

concentration by effortlessly paying attention to nature (Kaplan & Kaplan, 1989). Stress

Reduction Theory claims that being in nature reduces stress and improves physiological

functions such as heartrate and blood pressure (Ulrich et al., 1991). Biophilia Hypothesis

poses that humans have inherent need to be affiliated with nature (Kellert & Wilson, 1995).

Spending time in nature provides preventive health effects by reducing stress and

strengthening our immune system (Song, Ikei & Miyazaki, 2016). Affect regulation, a key

factor for wellbeing (Gross, 2013), is another possible mechanism of how nature heals our

mental health (Richardson, McEwan, Maratos & Sheffield, 2016).

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Likewise, there are various theories attempting to capture the complex nature of

addiction to explain its aetiology and to provide treatment modalities. The Brain-Hijack

Theory (Volkow & Li, 2005) regards addiction as a dysfunction of the brain’s reward system.

The emphasis on biology rather than morality reduces the stigma associated with addiction

and increases access to treatment (Hyman, 2007). The Excessive Appetites Model of

Addiction (Orford, 1985) challenges the Disease Model (believing the origin of addiction to

be neurological, genetic and environmental), and focuses on psychological aspects to

appraise how people become addicted to appetitive behaviours, such as sex, in the same way

they become addicted to substances. The Biopsychosocial Model (Marlatt & VandenBos,

1997) defines addiction as a complex behaviour pattern impacted by biological, sociological,

psychological and behavioural components. In this model, addictive behaviour is

distinguished from other problem behaviours by the individual’s overwhelming, pathological

lack of control. More recently, research at the intersection of neuroscience and psychology

suggests that addicted individuals have substantial impairments in cognitive control of

behaviour, but further evidence is still needed to support this mechanism (Morgenstern,

Naqvi, Debellis & Breiter, 2013). While these theories shed some light on the mechanism of

addiction, how these addiction theories would be related to the effects of shinrin-yoku has not

yet been explored.

Suggestions for future research

Considering these advantages of shinrin-yoku that meet today’s global needs,

addiction research can benefit from evaluating the effects of shinrin-yoku. However, new

studies need to overcome limitations of the existing shinrin-yoku research. For example,

many studies did not evaluate the effects of shinrin-yoku in the long-run, and only compared

with the urban settings, which would worsen mental health by itself in the first place.

Additionally, the only one shinrin-yoku study targeted alcoholics evaluated the effects of a

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nine-day programme on depression only (Shin, Shin & Yeoun, 2012); the degree of alcohol

misuse was not assessed, and shorter interventions should be evaluated to be practiced at

wider settings. Therefore, future addiction research needs to i) assess the effects of brief

shinrin-yoku practice on addiction in the long-run by establishing a rigorous follow-up

assessment, ii) compare with other addiction interventions, and iii) discuss theories and/or

mechanism of how shinrin-yoku might work for addiction.

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La práctica de Shinrin-Yoku (baño de bosque) es una modalidad terapéutica de inmersión en la naturaleza mediante el uso consciente de los sistemas senso-perceptivos. Se considera una intervención de bajo coste, preventiva y complementaria al tratamiento habitual, que puede promover la salud física y mental. El presente ensayo clínico controlado evalúa el impacto de la práctica guiada de baños de bosque en 46 participantes de 18 a 75 años con sintomatología de ansiedad y/o depresión leve del área básica de Atención Primaria Sabadell 4B. Los participantes fueron distribuidos de forma aleatoria en dos brazos, con un diseño cruzado. Se ejecutaron 2 sesiones de práctica guiada de baños de bosque, y se cumplimentaron formularios de evaluación online antes y después de cada sesión, durante 24 horas posteriores, así como antes y después del conjunto del programa. Los resultados preliminares muestran un impacto inmediato de los baños bosque con una reducción del estrés, ansiedad y afectividad negativa y un aumento de la plena conciencia de los pensamientos, emociones y sensaciones corporales; así como la experimentación de emociones agradables, aumento de la interacción con las otras personas y percepción de los retos de la vida de una manera adaptativa. La intervención diseñada, basada en la atención centrada en el paciente, así como los principios de efectividad y seguridad, muestra cómo los baños de bosque pueden proporcionar resultados para mantener y mejorar la salud.

Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders

Article

Nov 2023
AM J DRUG ALCOHOL AB

Background: There exists an underexploited opportunity to develop innovative therapeutic approaches to SUDs based upon the complementarity between modern and traditional health systems.Objectives: Illustrate the feasibility and potentiality of such an approach through the comprehensive description of Takiwasi Center's treatment model and program, where health concepts and practices from traditional Amazonian medicine work synergistically with modern psychotherapy and medicine in an intercultural dialog to assist in the rehabilitation of people suffering from SUDs.Methods: The description was built from a review of the literature, institutional data, participatory observation and unstructured interviews with staff, researchers and patients during treatment.Results: Since the foundation of the Takiwasi Center in 1992 in the peruvian Amazon, more than a thousand patients with different socio-cultural, ethnic and religious backgrounds have received residential treatment. We present how traditional Amazonian medicine techniques and health concepts cooperate to complement modern psychology in a therapeutic community setting and propose some hypotheses about the neurobiological, psycho-emotional and spiritual healing mechanisms triggered by the program to help people identify and heal the roots of their substance misuse and addictive behavior. We also summarize quantitative outcomes during treatment showing significant improvements in a wide variety of mental health indicators.Conclusion: Takiwasi Center's program is an option for people seeking non-conventional treatment who are sensitive to traditional Amazonian medicine practices and ready to explore the roots of their addiction. From this intercultural approach, some lessons could emerge toward a broader understanding of SUDs that may result in better patient care.

Making Sense of the Relationship Between Physical Activity and Mental Health: An Ecological View of Physical Activity

Article

Full-text available

Jun 2023

Physical activity has consistently shown to improve mental health. However, the mechanism of how those activities help mental health remains debated. Attempts have been made to explain that physical activity induces numerous molecular and structural changes in the brain that markedly improve symptoms associated with mental health issues such as depression and anxiety disorders. While studies report a generalised relationship between physical activity and mental health, which types of exercise are more advantageous than others, remains to be evaluated. Moreover, elite athletes are often considered a vulnerable group for mental health issues and targeted in this type of research, while physical activity benefits many others. This paper aims to elucidate the issue through an ecological view of cognitive science. A view that stipulates that the brain is inextricably linked via the body to its environment in an agent-environment relationship for which it has evolved for. Such a relationship makes some aspects of the environment more salient than others based on what it affords the agent. We argue that the biological adaptations associated with physical activity only tell half the story, and that the improvement of mental health stems from what these biological adaptations offer the agent by opening them to a greater number of meaningful affordances.

Effects of Shinrin-Yoku (Forest Bathing) and Nature Therapy on Mental Health: a Systematic Review and Meta-analysis

Article

Full-text available

Feb 2022
Int J Ment Health Addiction

Shinrin-yoku (forest-bathing), immersing oneself in nature using one's senses, has been receiving increased attention internationally. While most of the existing studies have focused on physical health, this systematic review and meta-analysis examined the mental health benefits of shinrin-yoku (i.e., depression, anxiety, anger), using the PRISMA guidelines (PROSPERO registery: BLINDED). Articles in English were retrieved on research databases including PubMed/MEDLINE, PsycINFO, Science Direct, and Google Scholar. Of 481 articles retrieved, twenty met the inclusion criteria (eight non-randomised and twelve randomised controlled trials). All studies were conducted in Asia and Europe and used a variety of different bathing approaches (e.g., breathing, walking, yoga). While noting a need for more rigorous research and more extensive follow-up assessments, the findings indicate that shinrin-yoku can be effective in reducing negative mental health symptoms in the short-term (large effects, g> .80); particularly, the effects on anxiety were largest. Overall, forest bathing improved depression, anxiety and anger in the short-term but there were a number of moderators of the effects. More careful examination of shinrin-yoku practices are needed; longer follow-up with participants from a range of countries along with greater examination of potential mechanisms of action are needed for shinrin-yoku to be accepted into mainstream interventions.

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review

Article

Full-text available

Dec 2019

Aims: This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine. Method: Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study. Result: The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people's emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression. Conclusion: Forest bathing activities may significantly improve people's physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.

Pathways to Sex Addiction: Relationships with Adverse Childhood Experience, Attachment, Narcissism, Self-Compassion and Motivation in a Gender-Balanced Sample

Article

Full-text available

May 2019

Research about sex addiction and its relationships with other constructs remains unexplored. We recruited a gender-balanced sample (53 men, 51 women) who responded to measures of sex addiction, adverse childhood experience, adult attachment, narcissism, self-compassion and motivation. Sex addiction was found to be statistically significantly associated with these constructs. Anxious attachment statistically significantly mediated the relationship between adverse childhood experience and sex addiction and the relationship between narcissism and sex addiction. Self-compassion did not statistically significantly moderate the relationship between anxious attachment and sex addiction. Therapeutic approaches targeting attachment and narcissism such as relation-based or mindfulness-based interventions are recommended.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Article

Full-text available

Nov 2018

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury.

Global statistics on alcohol, tobacco and illicit drug use: 2017 status report

Article

Full-text available

May 2018

Aims This review provides an up‐to‐date curated source of information on alcohol, tobacco, and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods Online data sources were identified through expert review. Data were mainly obtained from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation. Results In 2015, the estimated prevalence among the adult population was 18.3% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8%, 0.77%, 0.37%, and 0.35% for past‐year cannabis, amphetamine, opioid, and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardised prevalence of alcohol dependence was 843.2 per 100,000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100,000 people, respectively. High‐Income North America region had among the highest rates of cannabis, opioid, and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco (110.7 deaths per 100,000 people), followed by alcohol and illicit drugs (33.0, and 6.9 deaths per 100,000 people, respectively). Attributable age‐standardised mortality rates and DALYs for alcohol and illicit drugs were highest in Eastern Europe; attributable age‐standardised tobacco mortality rates and DALYs were highest in Oceania. Conclusions In 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing a further tens of millions. Europeans proportionately suffered more but in absolute terms the mortality rate was greatest in low and middle income countries with large populations and where the quality of data was more limited. Better standardised and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.

Investigating the Links between Fear of Missing Out, Social Media Addiction, and Emotional Symptoms in Adolescence: The Role of Stress Associated with Neglect and Negative Reactions on Social Media

Article

Feb 2020
ADDICT BEHAV

Fear of missing out (FoMO) is known to be associated with a decrease in emotional well-being in adolescents. However, few studies have investigated the possible mediating factors between FoMO and emotional symptoms. In this study, we studied the relationship between FoMO and emotional symptoms in a sample of 472 Italian adolescents aged 11-19. In particular, the study investigated the possible mediating role of perceived stress associated with experiences of neglect and negative reactions by other social media users, and social media addiction. Self-report measures were used. Results show that FoMO directly and indirectly predicts emotional symptoms. Additionally, FoMO is associated with increased sensitivity to stress associated with experiences of neglect and negative reactions by online peers, and social media addiction. Sensitivity to stress associated with neglect (but not to negative reactions) by online peers is found to mediate the relationship between FoMO and social media addiction, which, in turn, mediates the relationship with emotional symptoms. In general, the study shows that FoMO is a factor in experiencing higher sensitivity to stress associated with neglect by online peers, which in turn my act as a trigger for social media addiction, and ultimately showing a negative impact on emotional well-being of adolescents. Limits and future directions for research are discussed.

Which sports are more at risk of physical exercise addiction: A systematic review

Article

Dec 2018
ADDICT BEHAV

Introduction : Excessive physical exercise may evolve into physical exercise addiction, a recently identified entity with many yet unclear aspects, such as global prevalence and variability according to different types of physical exercise. Methods : We systematically reviewed the current literature up to June 2018 to collect all studies screening exercise addiction with two of the most frequently used screening scales: the Exercise Addiction Inventory (EAI) and the Exercise Dependence Scale (EDS). Results : We detected forty-eight studies (20 using the EAI, 26 the EDS, and 2 both scales) reporting variable point prevalence of exercise addiction risk, depending on the target population and the investigated sport. The EAI identifies a higher proportion of people at risk for physical exercise addiction among endurance athletes (14,2%) followed by ball games (10,4%), fitness centre attendees (8,2%) and power disciplines (6,4%), while a frequency of 3,0% was reported in the general population. Studies using the EDS found discrepant results. Discussion : This systematic review suggests that sport disciplines are associated with different vulnerability for physical exercise addiction. Besides the different addictive potential of each sport, the heterogeneity of results may be also due to socio-demographic and cultural characteristics of the target populations. The EAI and the EDS identify different proportions of individuals at risk for exercise addiction both in general population and in specific sport categories. As the EAI screens a higher proportion of subjects at risk, especially in endurance disciplines, it could be more appropriate for early detection of at-risk subjects and/or disciplines. Conclusion : Tailored prevention strategies for each discipline could help better preserving benefits of sports. More precision in research methods and the use of the most appropriate scale are required to allow a better comparability of prevalence among physical exercise disciplines and in general population.

Relationship between anxiety, depression, sex, obesity, and internet addiction in Chinese adolescents: A short-term longitudinal study

Article

Dec 2018
ADDICT BEHAV

The Lancet Commission on global mental health and sustainable development

Article

Oct 2018

Patterns of substance use and mortality risk in a cohort of ‘hard-to-reach’ polysubstance users: Patterns of substance use and mortality risk

Article

Oct 2017

Aims: To examine the mortality risk in a cohort of "hard-to-reach" polysubstance users and its putative associations with substance use. Specifically, we estimated all-cause mortality risk as a function of individual substance use indicators, and then as a function of their complex, "real-life" patterns as identified through Latent Class Analysis (LCA). Design: Prospective cohort study among street-and low-threshold-service-recruited polysubstance users included between September and November 2013 and followed through the National Cause of Death Registry until 31 October 2015. Setting: Seven Norwegian cities. Participants: 884 users of illegal opioids and/or stimulants. Of these, 357 were in opioid substitution treatment (OST) at the time of inclusion. Forty-four participants died during follow-up. Measurements: Primary outcome: All-cause mortality risk. Unadjusted and adjusted Cox proportional hazard (PH) regression models (covariates: male, age, homelessness/shelter use, overdose experience, OST status, years of injecting, individual substance use indicators, city, use patterns). LCA models estimated separately for those in and those not in OST due to measurement invariance. Findings: The crude mortality rate was 2.52 per 100 person-years. Standardized mortality ratio was 26.11 (95% confidence interval (CI) 10.06-54.87) for women and 10.71 (95% CI 6.39-16.81) for men. No single drug use indicator, such as "heroin injection" or "number of drugs used", was associated with the mortality risk. However, meaningful use patterns were identified; three OST and non-OST patterns each. The non-OST patterns "Polysubstance injectors" (HR=3.44 95% CI 0.98-12.14) and "Low frequent injectors" (HR=3.17 CI 1.05-9.56) were significantly associated with the mortality risk even when adjusted for other known risk factors. Conclusions: In a Norwegian prospective cohort study, "hard-to-reach" polysubstance users had more than ten times higher mortality risk than the general population. Mortality risk was not a function of any single drug use indicator, but two distinct combinations of substances, frequencies and routes of administration were associated with the mortality risk.

Commentary: Suggesting Shinrin-Yoku (Forest Bathing) for Treating Addiction

Abstract

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