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30 - Tanning as an Addiction: The State of the Research and Implications for Intervention

from Part V - Ongoing and Future Research Directions

Published online by Cambridge University Press:  13 July 2020

Steve Sussman
Affiliation:
University of Southern California
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Summary

Skin cancer is a major public health issue with global rates of disease steadily on the rise. Intentional tanning behaviors, including sunbathing and indoor tanning, are high-risk practices strongly associated with an increased risk of skin cancer. Despite the known health risks, both indoor and outdoor tanning remain popular, particularly among young adult non-Hispanic white women. While all tanning increases the risk of skin cancer, in a subset of those who tan the behavior becomes frequent and excessive, with addiction-like properties. “Tanning addiction” is thus associated with the characteristics of other addictions such as craving for the behavior, a reinforcing effect, an inability to quit, and resulting adverse health consequences related to the behavior. Motivations driving tanning addiction may stem from both psychological factors such as appearance norms and from the physiologic effects of exposure to ultraviolet light on brain reward pathways influencing mood. In this chapter we present the concept of tanning as an addiction, reviewing its definition, measurement, and prevalence in the population, and outlining the empirical evidence for the behavioral and biological drivers of tanning addiction. The implications of this research, we suggest, warrants greater attention to this emerging addiction, and necessitates the development of effective prevention and treatment interventions in those at risk of addictive tanning.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

American Psychiatric Association [APA] (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edition). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington, DC: American Psychiatric Association.Google Scholar
Ashrafioun, L. & Bonar, E. E. (2014a). Development of a brief scale to assess frequency of symptoms and problems associated with tanning. Journal of the American Academy of Dermatology, 70(3), 588-589. doi:10.1016/j.jaad.2013.11.041Google Scholar
Ashrafioun, L. & Bonar, E. E. (2014b). Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse. Journal of the American Academy of Dermatology, 70(3), 473480. doi:10.1016/j.jaad.2013.10.057CrossRefGoogle ScholarPubMed
Ashrafioun, L. & Bonar, E. E. (2015). Psychometric assessment of the craving to tan questionnaire. American Journal of Drug and Alcohol Abuse, 41(1), 7481. doi:10.3109/00952990.2014.939754CrossRefGoogle ScholarPubMed
Aubert, P. M., Seibyl, J. P., Price, J. L., et al. (2016). Dopamine efflux in response to ultraviolet radiation in addicted sunbed users. Psychiatry Research, 251, 714. doi:10.1016/j.pscychresns.2016.04.001Google Scholar
Aumann, T. D., Raabus, M., Tomas, D., et al. (2016). Differences in number of midbrain dopamine neurons associated with summer and winter photoperiods in humans. PLoS ONE, 11(7), e0158847. doi:10.1371/journal.pone.0158847CrossRefGoogle Scholar
Baler, R. D. & Volkow, N. D. (2006). Drug addiction: the neurobiology of disrupted self-control. Trends in Molecular Medicine, 12(12), 559566. doi:10.1016/j.molmed.2006.10.005Google Scholar
Banerjee, S. C., Hay, J. L. & Greene, K. (2013). Cognitive rationalizations for tanning-bed use: a preliminary exploration. American Journal of Health Behavior, 37(5), 577586. doi:10.5993/ajhb.37.5.1CrossRefGoogle ScholarPubMed
Berridge, K. C. & Robinson, T. E. (2016). Liking, wanting, and the incentive-sensitization theory of addiction. American Psychologist, 71(8), 670679. doi:10.1037/amp0000059Google Scholar
Blum, K. et al. (2020). Precision Behavioral Management (PBM): a novel genetically guided therapy to combat Reward Deficiency Syndrome (RDS) relevant to the opiate crisis. In Sussman, S. (Ed.) The Cambridge Handbook of Substance and Behavioral Addictions. Cambridge, UK: Cambridge University Press, pp. 297306Google Scholar
Boniol, M., Autier, P., Boyle, P. & Gandini, S. (2012). Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ, 345, e4757. doi:10.1136/bmj.e4757Google Scholar
Cartmel, B., Dewan, A., Ferrucci, L. M., et al. (2014). Novel gene identified in an exome-wide association study of tanning dependence. Experimental Dermatology, 23(10), 757759. doi:10.1111/exd.12503Google Scholar
Chait, S. R., Thompson, J. K. & Jacobsen, P. B. (2015). Preliminary development and evaluation of an appearance-based dissonance induction intervention for reducing UV exposure. Body Image, 12, 6872. doi:10.1016/j.bodyim.2014.09.004Google Scholar
Dulcis, D., Jamshidi, P., Leutgeb, S. & Spitzer, N. C. (2013). Neurotransmitter switching in the adult brain regulates behavior. Science, 340(6131), 449453. doi:10.1126/science.1234152Google Scholar
Earleywine, M., LaBrie, J. W. & Pedersen, E. R. (2008). A brief Rutgers Alcohol Problem Index with less potential for bias. Addictive Behaviors, 33(9), 12491253. doi:10.1016/j.addbeh.2008.05.006Google Scholar
FDA (2014). General and plastic surgery devices: reclassification of ultraviolet lamps for tanning, henceforth to be known as sunlamp products and ultraviolet lamps intended for use in sunlamp products. Final order. Federal Registister, 79(105), 3120531214.Google Scholar
FDA (2015). General and plastic surgery devices: restricted sale, distribution, and use of sunlamp products. Retrieved from www.federalregister.gov/documents/2015/12/22/2015-32024/general-and-plastic-surgery-devices-restricted-sale-distribution-and-use-of-sunlamp-productsGoogle Scholar
Feldman, S. R., Liguori, A., Kucenic, M., et al. (2004). Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. Journal of the American Academy of Dermatology, 51(1), 4551. doi:10.1016/j.jaad.2004.01.053CrossRefGoogle ScholarPubMed
Fell, G. L., Robinson, K. C., Mao, J., Woolf, C. J. & Fisher, D. E. (2014). Skin beta-endorphin mediates addiction to UV light. Cell, 157(7), 15271534. doi:10.1016/j.cell.2014.04.032CrossRefGoogle ScholarPubMed
Feng, J., Frisard, C., Nahar, V. K., et al. (2017). Gender differences in indoor tanning habits and location. Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2017.10.015Google Scholar
First, M., Spitzer, R., Gibbon, M. & Williams, J. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). New York: New York State Psychiatric Institute Biometrics Research Department.Google Scholar
Fisher, D. E. & James, W. D. (2010). Indoor tanning – science, behavior, and policy. New England Journal of Medicine, 363(10), 901903. doi:10.1056/NEJMp1005999CrossRefGoogle ScholarPubMed
Flannery, B. A., Volpicelli, J. R. & Pettinati, H. M. (1999). Psychometric properties of the Penn Alcohol Craving Scale. Alcoholism: Clinical and Experimental Research, 23(8), 12891295.Google Scholar
Flight, M. H. (2013). Synaptic transmission: summer blues. Nature Reviews Neuroscience, 14(6), 378. doi:10.1038/nrn3517CrossRefGoogle ScholarPubMed
Flores, K. G., Erdei, E., Luo, L., et al. (2013). A pilot study of genetic variants in dopamine regulators with indoor tanning and melanoma. Experimental Dermatology, 22(9), 576581. doi:10.1111/exd.12200CrossRefGoogle ScholarPubMed
Gambichler, T., Bader, A., Vojvodic, M., et al. (2002). Plasma levels of opioid peptides after sunbed exposures. British Journal of Dermatology, 147(6), 12071211.Google Scholar
Gibbons, F. X., Gerrard, M., Lane, D. J., Mahler, H. I. & Kulik, J. A. (2005). Using UV photography to reduce use of tanning booths: a test of cognitive mediation. Health Psychology, 24(4), 358363. doi:10.1037/0278-6133.24.4.358Google Scholar
Gillen, M. M. & Markey, C. N. (2012). The role of body image and depression in tanning behaviors and attitudes. Journal of Behavioral Medicine, 38(3), 7482. doi:10.1080/08964289.2012.685499Google Scholar
Guy, G. P. Jr., Berkowitz, Z., Everett Jones, S., et al. (2015). Trends in indoor tanning among US high school students, 2009–2013. JAMA Dermatology, 151(4), 448450. doi:10.1001/jamadermatol.2014.4677CrossRefGoogle ScholarPubMed
Guy, G. P. Jr., Berkowitz, Z., Everett Jones, S., Watson, M. & Richardson, L. C. (2017). Prevalence of indoor tanning and association with sunburn among youth in the United States. JAMA Dermatology, 153(5), 387390. doi:10.1001/jamadermatol.2016.6273CrossRefGoogle ScholarPubMed
Guy, G. P. Jr., Berkowitz, Z., Jones, S. E., et al. (2014). State indoor tanning laws and adolescent indoor tanning. American Journal of Public Health, 104(4), e6974. doi:10.2105/ajph.2013.301850Google Scholar
Guy, G. P. Jr., Berkowitz, Z., Watson, M., Holman, D. M. & Richardson, L. C. (2013). Indoor tanning among young non-Hispanic white females. JAMA Internal Medicine, 173(20), 19201922. doi:10.1001/jamainternmed.2013.10013Google Scholar
Guy, G. P. Jr., Watson, M., Richardson, L. C. & Lushniak, B. D. (2016). Reducing indoor tanning – an opportunity for melanoma prevention. JAMA Dermatology, 152(3), 257259. doi:10.1001/jamadermatol.2015.3007Google Scholar
Harrington, C. R., Beswick, T. C., Graves, M., et al. (2012). Activation of the mesostriatal reward pathway with exposure to ultraviolet radiation (UVR) vs. sham UVR in frequent tanners: a pilot study. Addiction Biology, 17(3), 680686. doi:10.1111/j.1369-1600.2010.00312.xGoogle Scholar
Harrington, C. R., Beswick, T. C., Leitenberger, J., et al. (2011). Addictive-like behaviours to ultraviolet light among frequent indoor tanners. Clinical and Experimental Dermatology, 36(1), 3338. doi:10.1111/j.1365-2230.2010.03882.xCrossRefGoogle ScholarPubMed
Heckman, C. J. & Manne, S. L. (2012). Shedding Light on Indoor Tanning. Dordrecht; New York: Springer.Google Scholar
Heckman, C. J., Cohen-Filipic, J., Darlow, S., et al. (2014a). Psychiatric and addictive symptoms of young adult female indoor tanners. American Journal of Health Promotion, 28(3), 168174. doi:10.4278/ajhp.120912-QUAN-442Google Scholar
Heckman, C., Darlow, S., Cohen-Filipic, J. & Kloss, J. (2016). Mood changes after indoor tanning among college women: associations with psychiatric/addictive symptoms. Health Psychol Res, 4(1), 5453. doi:10.4081/hpr.2016.5453CrossRefGoogle ScholarPubMed
Heckman, C. J., Darlow, S., Kloss, J. D., et al. (2014b). Measurement of tanning dependence. Journal of the European Academy of Dermatology and Venereology, 28(9), 11791185. doi:10.1111/jdv.12243Google Scholar
Heckman, C. J., Darlow, S. D., Kloss, J. D., Munshi, T. & Manne, S. L. (2015). Contextual factors, indoor tanning, and tanning dependence in young women. American Journal of Health Behavior, 39(3), 372379. doi:10.5993/ajhb.39.3.10Google Scholar
Heckman, C. J., Egleston, B. L., Wilson, D. B. & Ingersoll, K. S. (2008). A preliminary investigation of the predictors of tanning dependence. American Journal of Health Behavior, 32(5), 451464. doi:10.5555/ajhb.2008.32.5.451Google Scholar
Hillhouse, J. J. & Turrisi, R. (2002). Examination of the efficacy of an appearance-focused intervention to reduce UV exposure. Journal of Behavioral Medicine, 25(4), 395409.CrossRefGoogle ScholarPubMed
Hillhouse, J. J., Baker, M. K., Turrisi, R., et al. (2012). Evaluating a measure of tanning abuse and dependence. Archives of Dermatology, 148(7), 815819. doi:10.1001/archdermatol.2011.2929Google Scholar
Hillhouse, J., Stapleton, J. & Turrisi, R. (2005). Association of frequent indoor UV tanning with seasonal affective disorder. Archives of Dermatology, 141(11), 1465. doi:10.1001/archderm.141.11.1465CrossRefGoogle ScholarPubMed
Hillhouse, J., Turrisi, R. & Shields, A. L. (2007). Patterns of indoor tanning use: implications for clinical interventions. Archives of Dermatology, 143(12), 15301535. doi:10.1001/archderm.143.12.1530Google Scholar
Hillhouse, J., Turrisi, R., Stapleton, J. & Robinson, J. (2008). A randomized controlled trial of an appearance-focused intervention to prevent skin cancer. Cancer, 113(11), 32573266. doi:10.1002/cncr.23922Google Scholar
Hillhouse, J., Turrisi, R., Stapleton, J. & Robinson, J. (2010). Effect of seasonal affective disorder and pathological tanning motives on efficacy of an appearance-focused intervention to prevent skin cancer. Archives of Dermatology, 146(5), 485491. doi:10.1001/archdermatol.2010.85Google Scholar
Holman, D. M., Fox, K. A., Glenn, J. D., et al. (2013). Strategies to reduce indoor tanning: current research gaps and future opportunities for prevention. American Journal of Preventative Medicine, 44(6), 672681. doi:10.1016/j.amepre.2013.02.014Google Scholar
Jussila, A., Huotari-Orava, R., Ylianttila, L., Partonen, T. & Snellman, E. (2016). Narrow-band ultraviolet B radiation induces the expression of beta-endorphin in human skin in vivo. Journal of Photochemistry and Photobiology B, 155, 104108. doi:10.1016/j.jphotobiol.2016.01.007Google Scholar
Kaur, M., Liguori, A., Lang, W., et al. (2006). Induction of withdrawal-like symptoms in a small randomized, controlled trial of opioid blockade in frequent tanners. Journal of the American Academy of Dermatology, 54(4), 709711. doi:10.1016/j.jaad.2005.11.1059Google Scholar
Kourosh, A. S., Harrington, C. R. & Adinoff, B. (2010). Tanning as a behavioral addiction. American Journal of Drug and Alcohol Abuse, 36(5), 284290. doi:10.3109/00952990.2010.491883Google Scholar
Le Foll, B., Gallo, A., Le Strat, Y., Lu, L. & Gorwood, P. (2009). Genetics of dopamine receptors and drug addiction: a comprehensive review. Behavioral Pharmacology, 20(1), 117. doi:10.1097/FBP.0b013e3283242f05Google Scholar
Leary, M. R., Saltzman, J. L. & Georgeson, J. C. (1997). Appearance motivation, obsessive-compulsive tendencies and excessive suntanning in a community sample. Journal of Health Psychology, 2(4), 493499. doi:10.1177/135910539700200406Google Scholar
Levins, P. C., Carr, D. B., Fisher, J. E., Momtaz, K. & Parrish, J. A. (1983). Plasma beta-endorphin and beta-lipoprotein response to ultraviolet radiation. The Lancet, 2(8342), 166.Google Scholar
Levran, O., Yuferov, V. & Kreek, M. J. (2012). The genetics of the opioid system and specific drug addictions. Human Genetics, 131(6), 823842. doi:10.1007/s00439-012-1172-4Google Scholar
Lim, H. W., James, W. D., Rigel, D. S., et al. (2011). Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. Journal of the American Academy of Dermatology, 64(5), 893902. doi:10.1016/j.jaad.2011.03.007Google Scholar
Mays, D., Atkins, M. B., Ahn, J. & Tercyak, K. P. (2017). Indoor tanning dependence in young adult women. Cancer Epidemiology, Biomarkers & Preention, 26(11), 16361643. doi:10.1158/1055-9965.EPI-17-0403Google Scholar
Miller, K. A., Piombo, S. E., Cho, J., et al. (2018). Prevalence of tanning addiction and behavioral health conditions among ethnically and racially diverse adolescents. Journal of Investigative Dermatology, 138(7), 15111517. doi:10.1016/j.jid.2018.02.018Google Scholar
Mosher, C. E. & Danoff-Burg, S. (2010a). Addiction to indoor tanning: relation to anxiety, depression, and substance use. Archives of Dermatology, 146(4), 412417. doi:10.1001/archdermatol.2009.385Google Scholar
Mosher, C. E. & Danoff-Burg, S. (2010b). Indoor tanning, mental health, and substance use among college students: the significance of gender. Journal of Health Psychology, 15(6), 819827. doi:10.1177/1359105309357091Google Scholar
Nilsen, L. T., Hannevik, M. & Veierod, M. B. (2016). Ultraviolet exposure from indoor tanning devices: a systematic review. British Journal of Dermatology, 174(4), 730740. doi:10.1111/bjd.14388Google Scholar
NIMH (2018). Seasonal Affective Disorder. Retrieved from www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtmlGoogle Scholar
Petit, A., Lejoyeux, M., Reynaud, M. & Karila, L. (2014). Excessive indoor tanning as a behavioral addiction: a literature review. Current Pharmaceutical Design, 20(25), 40704075.Google Scholar
Poorsattar, S. P. & Hornung, R. L. (2007). UV light abuse and high-risk tanning behavior among undergraduate college students. Journal of the American Academy of Dermatology, 56(3), 375379. doi:10.1016/j.jaad.2006.08.064Google Scholar
Poorsattar, S. P. & Hornung, R. L. (2010). Tanning addiction: current trends and future treatment. Expert Review of Dermatology, 5(2), 123125. doi:10.1586/edm.10.14Google Scholar
Rozin, P. & Stoess, C. (1993). Is there a general tendency to become addicted? Addictive Behavior, 18(1), 8187.Google Scholar
Schneider, S., Schirmbeck, F., Bock, C., et al. (2015). Casting shadows on the prevalence of tanning dependence: an assessment of mCAGE criteria. Acta Dermato-Venereologica, 95(2), 162168. doi:10.2340/00015555-1907CrossRefGoogle ScholarPubMed
Seidenberg, A. B., Mahalingam-Dhingra, A., Weinstock, M. A., Sinclair, C. & Geller, A. C. (2015). Youth indoor tanning and skin cancer prevention: lessons from tobacco control. American Journal of Preventative Medicine, 48(2), 188194. doi:10.1016/j.amepre.2014.08.034Google Scholar
Skobowiat, C., Dowdy, J. C., Sayre, R. M., Tuckey, R. C. & Slominski, A. (2011). Cutaneous hypothalamic-pituitary-adrenal axis homolog: regulation by ultraviolet radiation. American Journal of Physiology Endocrinology and Metabolism, 301(3), E484–493. doi:10.1152/ajpendo.00217.2011.10.1152/ajpendo.00217.2011CrossRefGoogle ScholarPubMed
Spiro, J., Parker, S., Oliver, I., et al. (1987). Effect of PUVA on plasma and skin immunoreactive alpha-melanocyte stimulating hormone concentrations. British Journal of Dermatology, 117(6), 703707.CrossRefGoogle ScholarPubMed
Stapleton, J. L., Hillhouse, J., Levonyan-Radloff, K. & Manne, S. L. (2017). Review of interventions to reduce ultraviolet tanning: need for treatments targeting excessive tanning, an emerging addictive behavior. Psychology of Addictive Behaviors, 31(8), 962978. doi:10.1037/adb0000289Google Scholar
Stapleton, J. L., Hillhouse, J. J., Turrisi, R., et al. (2016). The Behavioral Addiction Indoor Tanning Screener (BAITS): an evaluation of a brief measure of behavioral addictive symptoms. Acta Dermato-Venereologica, 96(4), 552553. doi:10.2340/00015555-2290Google Scholar
Sussman, S. (2017). Substance and Behavioral Addictions: Concepts, Causes, and Cures. Cambridge, UK; New York, NY: Cambridge University Press.Google Scholar
Sussman, S. & Sussman, A. N. (2011). Considering the definition of addiction. International Journal of Environmental Research and Public Health, 8(10), 40254038. doi:10.3390/ijerph8104025Google Scholar
Turrisi, R., Mastroleo, N. R., Stapleton, J. & Mallett, K. (2008). A comparison of 2 brief intervention approaches to reduce indoor tanning behavior in young women who indoor tan very frequently. Archives of Dermatology, 144(11), 15211524. doi:10.1001/archderm.144.11.1521Google Scholar
US Congress, t. C., 2nd Session (2010). Compilation of patient protection and affordable care act, as amended through May 1, 2010. Chapter 49, Section 5000B. Imposition of tax on indoor tanning services. Retrieved from http://housedocs.house.gov/energycommerce/ppacacon.pdfGoogle Scholar
US Department of Health and Human Services (2014). The Surgeon General’s Call to Action to Prevent Skin Cancer. Washington, DC.Google Scholar
Volkow, N. D., Fowler, J. S., Wang, G. J. & Swanson, J. M. (2004). Dopamine in drug abuse and addiction: results from imaging studies and treatment implications. Molecular Psychiatry, 9(6), 557569. doi:10.1038/sj.mp.4001507Google Scholar
Warlow, S. M. et al. (2020). Sensitization of incentive salience and the transition to addiction. In Sussman, S. (Ed.) The Cambridge Handbook of Substance and Behavioral Addictions. Cambridge, UK: Cambridge University Press, pp. 2337.Google Scholar
Warthan, M. M., Uchida, T. & Wagner, R. F. Jr. (2005). UV light tanning as a type of substance-related disorder. Archives of Dermatology, 141(8), 963966. doi:10.1001/archderm.141.8.963Google Scholar
Wintzen, M., de Winter, S., Out-Luiting, J. J., van Duinen, S. G. & Vermeer, B. J. (2001a). Presence of immunoreactive beta-endorphin in human skin. Experimental Dermatology, 10(5), 305311.CrossRefGoogle ScholarPubMed
Wintzen, M., Ostijn, D. M., Polderman, M. C., et al. (2001b). Total body exposure to ultraviolet radiation does not influence plasma levels of immunoreactive beta-endorphin in man. Photodermatology, Photoimmunology & Photomedicine, 17(6), 256260.CrossRefGoogle Scholar
World Health Organization (2018). Ultraviolet Radiation (UV). Retrieved from www.who.int/uv/en/Google Scholar

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