Some chronic indoor tanners have what looks like a substance-related disorder.
Excessive sunlamp and tanning bed use is linked to increased risk for both melanoma and nonmelanoma skin cancers. Repeat tanners may exhibit addictive behaviors similar to those exhibited by people addicted to substances such as alcohol. To determine whether tanning is a substance-related disorder (SRD), investigators modified two measures widely used to identify SRDs: the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire and the diagnostic criteria for SRDs in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Overall, 237 of the 421 study participants (56.3%) visited tanning salons during the previous year (mean number of sessions, 23). Of 229 patients eligible for analysis, 70 (30.6%) met modified CAGE (mCAGE) criteria, and 90 (39.3%) met the modified DSM-IV-TR criteria for addiction to indoor tanning. The mCAGE and mDSM-IV-TR results were significantly correlated but not associated with gender or skin type. Study participants who met the criteria for addiction to indoor tanning reported greater symptoms of anxiety, although only the frequency of indoor tanning significantly predicted tanning addiction status (P<0.001). Subjects who met addiction criteria also reported greater alcohol and marijuana use but not more tobacco or stimulant use; 21 of the 50 participants (42.0%) who met addiction criteria used two or more substances during the previous month. Comment: This study nicely demonstrates the psychological underpinnings of repetitive tanning use, shifting away from the behavior’s purely physical effects and substantially supporting the notion that indoor tanning addiction involves the same drives as other forms of SRD. Strengths of this study are its large numbers and its rigorous application of psychological metrics. It is important to distinguish addicted from nonaddicted users. The real challenge is to translate these findings into concrete interventions to reduce the risky behavior. Perhaps lessons gained from the study of other SRDs can be used as a template. — Hensin Tsao, MD, PhD
