Hensin Tsao, MD, PhD


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In This Article

Abstract and Introduction


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.


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