مصرف خودسرانه داروها و رضایت در پی انگیزش های دوگانه اساسی در زمینه اختلالات رفتاری

Social concern is increasing about the perceived negative effects from consuming a number of legal products including gambling, alcohol, and food. This study uses data from a clinic treating gambling and other behavioral disorders to test the theory that different motivations may exist in the consumption of legal products that harm health and well-being. Pathological consumers whose goal is self-medication are more likely to have correlated consumption disorders (e.g., other substance dependencies) than those whose goal is pure pleasure. Self-medicators demonstrate a positive correlation between the severity of their consumption problems and having other substance dependencies. This finding suggests that gambling and other substance dependencies are means of self-medication to one category of pathological gamblers. Furthermore, because self-medicators can more easily substitute among different problem consumptions (e.g., switch from gambling to illicit drugs) for the same goal, they are less likely than pleasure seekers to commit crimes to facilitate their gambling. The possible predictors of motivation types and their implications are further discussed.

Popular and normal acts of consumption can be threats to individuals' health and well-being. For example, negative consumption effects associate with food (Patton et al., 1999 and Prentice, 2001), alcohol (Pennock & Kerr, 2005), shopping (O'Guinn and Faber, 1989 and Rook, 1987), gambling (Blaszczynski & Nower, 2002), driving automobiles (Insurance Information Institute, 2008), and prescription drugs (Goldsworthy, Schwartz, & Mayhorn, 2008). Marketing practices can be drivers in creating and popularizing consumption that result in negative effects. Research into advertising (Wansink & Ray, 1996), promotions (Ailawadi & Neslin, 1998) and health claims and nutritional information (Kozup, Creyer, & Burton, 2003) generally shows some positive influence on consumption behaviors. Marketing can influence consumers by manipulating affect or emotions (e.g., Mick & DeMoss, 1990), mood (Andrade, 2005 and Wansink et al., 2003), and a combination of the nature of the product and the consumer's affective state (Garg, Wansink, & Inman, 2007). However, marketing and psycho-social research generally neglects investigations into consumer motivation (Bagozzi & Dholkia, 1999). The limited research into consumer behavior resulting in negative effects generally characterizes these behaviors as consequences of failed self-control (e.g., Faber et al., 1995 and O'Guinn and Faber, 1989). To date, conceptualizations of the existence of different pathways or motivations that lead to repeated acts of behavior resulting in negative effects (Blaszczynski and Nower, 2002, Hirschman, 1992 and Hoch and Loewenstein, 1991) lack empirical support. This study distinguishes between two types of dysfunctional consumptions, on the basis of primary motivations, namely, pure pleasure seeking versus self-medication. Pure pleasure seeking leads to narrowly focused consumption interests (e.g., less likelihood of substituting gambling for substance use) and more social complications (e.g., committing crime to facilitate gambling), whereas the goal of self-medication leads to a wider variety of consumption alternatives (e.g., pathological gamblers are more likely to have one or more other substance dependencies) but fewer social complications (e.g., lower rates of crime to facilitate gambling).

Drawing on the theory of goal systems (Kruglanski et al., 2002), this research investigates the implications of differing motivations of pathological gamblers to reveal new complexities associated with dysfunctional consumption. The underlying motivations of pathological consumption predict a pathological consumer's potential problems in other consumption domains. Pathological gamblers escaping the painful reality of life by gambling are significantly more likely to have other substance dependencies than pure pleasure seekers. In addition, when gambling problems progress from mild to pathological, the likelihood of having substance dependencies decreases for pleasure-seeking gamblers, whereas self-medication gamblers present the opposite pattern. The finding that pathological gamblers who gamble to escape are more likely to have other substance dependencies than pure pleasure-seeking pathological gamblers has implications for comorbid consumption. Prior consumer research largely focuses on the difference between normal consumers and compulsive consumers in examining the comorbidity issue (Faber et al., 1995). Significant heterogeneity likely exists even among pathological consumers conclusion also has implications for the effect that the stimuli from one domain can affect consumption patterns in other domains (Li, 2008 and Van den Bergh et al., 2008). Supporting the third hypothesis, self-medicators are less likely to commit illegal acts to facilitate their consumption behaviors when compared with pure pleasure seekers. The result ensues because pathological consumers motivated by self-medication have substitutive means to satisfy their goal, and those who gamble for pure pleasure do not. Further evidence of the dichotomy of pathological consumption includes the finding that self-medicators are more likely to have a parent who was also engaged in the same form of consumption (e.g., gambling). Previous research on the hereditary nature of compulsive consumption reveals equivocal findings. Children of a compulsive consumer, on the one hand, are more likely to develop the same problem and, on the other, are less likely to be involved in social complications or to have the most severe consequences because of the problem consumption. The children of a compulsive consumer are more likely to experience distress and therefore are more likely to undertake negative consumption to escape their distressed state. Thus, the products that the parents consumed become the most salient means for their offspring to achieve their self-medication goal. However, as this study shows, the distressed type of compulsive consumers are less likely to be involved in social complications, and thus, the hereditary nature of compulsive consumption will not lead to more severe problems in their consumption. 5.1. Implications for policy makers and business The findings in the present study imply that restricting access to gambling products might encourage or force those who gamble for self-medication to substitute gambling with other products that satisfy the same goal. These findings prompt the question whether restricting product access (i.e., fewer products and less availability) would result in more serious problems in other areas for those who derive self-medication benefits from gambling (or other acts of consumption). Indeed, if rationality is understood to be a consistent plan to maximize utility over time (Becker & Murphy, 1988), pathological behavior in one domain may be a rationalized decision for self-medicators. This perspective implies that the terms compulsive and failure to control may not accurately describe the pathology or the cause. Thus, a great deal of the research concerning negative consumption effects may be misspecified, and ultimately, the resulting policy may be suboptimal. Self-medicators, though technically classifiable as pathological gamblers under the present scales (e.g., DSM, CPGI), actually derive positive outcomes from gambling (assuming that gambling is not as harmful as some of the alternative methods of escape). Implicitly, estimates of the number of problem gamblers, and the resulting cost–benefit analysis that underpins much gambling policy, should be based on pleasure seekers rather than all who meet the screening questionnaires' cut-off points. Governments heavily regulate the gambling industry because of the policy imperatives intended to protect consumers from negative effects. A clear need exists for the industry to better understand the behaviors and the underlying motivations of problem gambling. This research is relevant to industry and other stakeholders, as the findings provide insights into the understanding of the motivations and comorbid consumption of pathological gamblers, which may facilitate the development of more effective responsible gambling and social marketing programs. 5.2. Implications for the management of people with problems Mental health providers widely debate the best ways to treat pathological gamblers. The finding that dual (and possibly more) motivations exist in pathological gambling implies that differing approaches could exist that are applied to marketing help services and to helping compulsive consumers. For instance, treating the mood problem or mental ailment of a self-medicator or counseling them on a less destructive path before asking them to quit gambling might be more beneficial. Thus, marketing counseling services specific to gambling products may be counter-productive, but using similar marketing channels (e.g., inside casinos, community service announcements in the media) with messages targeting other comorbid traits or aimed at mood improvement may be more effective. This finding would also imply that specialized gambling counselors require additional skill sets to understand other disorders and how these can affect problem gambling. 5.3. Limitations and future directions The study has the following limitations. First, all the tests are correlational tests, which do not prove causal relationships. Second, the changes in the social and economic contexts, which are not coded in the data, might provide alternative, possible explanations. In addition, many of the responses may be specific to one geographic area and may not be generalized. Thus, replicating this research in other geographic areas and consumption environments would increase the generalizability of the research. The categorization of motivational types is based on one assessment item, and this study relies on the assumption that if pathological consumers do not seek self-medication from compulsive consumption, they would be driven by the pleasure or excitement that they anticipate from the gambling activities. The validity of this assumption requires further research. Further research should also investigate whether other types or subtypes of motivators for pathological consumption exist. The difficulty of studying the pathological consumption prevents further laboratory studies for this research. As Mick (1996) shows, social desirability can confound dark side variables (e.g., drug addiction, gambling). The clinical data in this study are likely the best source to mitigate socially desirable responses. When gamblers seek help from doctors and treatment from clinics, they may be most likely to disclose their real attitudes toward dark side variables. However, changing the standard treatment procedure by asking clients more questions (e.g., with more complex structures) would be unethical. More research is needed to extend the central finding of this research that dichotomous motivations exists for consumption with negative effects into other areas of concern, such as alcohol and food consumption. In context with the gambling research in this study, a deeper understanding is needed of the types of gambling products (and their product attributes) that are most attractive to different categories of gamblers. Another issue deserving investigation relates to the products (and the various features preferred), frequency, expenditure (as a proportion of income and assets), time of day, and duration of incidents of negative consumption. Far greater insights are necessary into how consumption patterns differ between self-medicators, pleasure seekers, and “ordinary” consumers within product categories (e.g., gambling, food) and across domains. A final extension of this research is identifying any triggers or early indicators of consumption with negative effects.