-June 19, 2018
On Monday they World Health Organization declared that they are now recognizing video game addiction as a disorder. This is a big deal, and something that has been in debate for many years. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMV), the American Psychological Association declined to add video game addiction to the manual. In their reasoning for this they said that video game addiction is “a condition warranting more clinical research and experience before it might be considered for inclusion”.
They further said that in regards to internet gaming “studies suggest that when these individuals are engrossed in internet games, certain pathways in their brains are triggered in the same direct and intense way that a drug addict’s brain is affected by a particular substance”, and, “The gaming prompts a neurological response that influences feelings of pleasure and reward, and the result, in the extreme, is manifested as addictive behaviour.”
This has been an interesting debate to follow. In my own experience, and that of many parents I have seen in therapy, video game addiction is definitely a very real thing. But how pervasive is it? What causes it? And how can we help people who are struggling with it? These are some things I am going to talk about in this blog post.
Gaming Disorder as Defined by the W.H.O
When any new disorder is recognized, it takes some time for the psychological community to come up with a precise definition of the diagnosis. The current prevailing diagnostic guidelines defined by the International Classification of Diseases (ICD-11) are:
a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.
For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.
Why This is a Bad Thing
Not all gamers are addicts.
This description in the ICD-11 will likely sound familiar to many parents. Indeed, I have seen a great number of teens in therapy who are absolutely dependent on their video games. But it is important to note here that not all gamers are addicts…..This has actually been confusing to me over the years. I sometimes find myself slightly bewildered when people don’t obsess over video games. I myself will openly admit that I am a video game addict. I can’t casually play a game. If I’m going to do it, it becomes my life until it’s done. And that’s one of the problems we are facing in the emergence of video game addiction; many modern games don’t have an “end” and are designed to be addictive. Despite this, many people can, and do, play video games without becoming addicted to them. Many people worry that recognizing video game addiction may pave the way for further stigmatization of video games.
Why This is a Good Thing
Classifying video game addiction as a disease is a good thing because doing so can bring it to light as an actual problem. There are many people in the world who struggle with very real, debilitating video game addiction. Any time something like this gets recognized as a disorder, it opens the door to research, new forms of treatment, and potential coverage by insurance companies. All of this will allow for greater recognition and treatment resources for those who are struggling with this addiction.
How Video Game Addiction Happens
Some video games are designed to be addictive.
Back in grad school, when I was working on my thesis about video games and personality, I remember reading an article that talked about game theory and how video games are designed to be addictive. They are basically systems designed to shape behavior through rewards and punishments. Take a look at one of the most known video games of all. Super Mario Brothers, back on the NES, essentially trained players to perform certain tasks, no different than a researcher would do with rats in a lab. Players are rewarded for stomping on bad guys and punished for running into them. Over time player behavior is shaped towards the desired behavior: avoiding obstacles and progressing to the final castle.
The Problem is by Design
The problem with modern gaming is that it is designed to be addictive. The gaming industry has built upon the principles of behavior modification I just talked about, and refined them into something that drives addiction. I have been wanting to write about how video games foster addiction, and I will do so more thoroughly in a later blog, but for now, here are just a few reasons modern gaming is so addictive:
- Many have no endings. Players can infinitely “level up” and run on the proverbial rat wheel chasing the cheese that is just out of reach.
- Many games involve high levels of competition that leave players yearning to be better than their friends.
- They’re social. A lot of games weave social incentives in that key in on the basic human drive to feel included.
- Some games build in systems that incentivize players to check in daily
- Many games continue while the player is not logged on, this paired with the incentive to check in daily make for obsessive thinking.
- I’m going to talk about 3 major other points in more detail: Intermittent rewards schedules, microtransactions, and skins.
Rewards are intermittent
In behavioral psychology there are various strategies to train people (and animals) to perform certain behaviors. Most of these strategies revolve around systems of rewards and punishments. Subjects are trained to perform a certain behavior and that behavior is reinforced through rewards and/ or punishments. We have known for years that the most effective and “addictive” form of reinforcement schedule is that which is intermittent. In these cases, subjects are rewarded for performing desired behaviors, but only intermittently. This is commonly compared to gambling; you pull the lever a bunch of times, occasionally something good happens, but every now and then something amazing randomly happens. This is the most addictive form of reinforcement and many modern video games cash in on this. Players are given chances to receive in game items that vary in rarity and play on this same system of intermittent reinforcement.
Oh boy….let me tell you about micro transactions. This is the big kicker in my opinion. Many, many, many games nowadays thrive on a system of “microtransactions”. These are relatively small purchases players make in games to receive in game content. They’re considered to be “micro” because they are usually small in comparison to the traditional full price of a game. Games that use microtransactions typically basically amount to legalized forms of gambling. Players pay for a “crate” or “loot box” or a pack of virtual cards or something and have a random chance of finding something good. The problem is that many games make the chances of getting anything valuable very very slim…..which makes them tantamount to pulling a lever on a slot machine. I’m going to write a whole blog about this later, but for now lets enjoy this video of a man spending $900 dollars trying to get a virtual Whinnie the Pooh card on a game I played a couple years ago…..Actually, it looks like that video doesn’t exist anymore, but I promise it was a thing….and it was sad.
Many games that involve microtransactions offer players the chance to get different “skins”. In these games the word “skins” refers to anything you can get that changes the appearance of the player’s character. Generally these skins don’t add any special powers or abilities to players….they just make them look differently. I can’t tell you how many kids I have had in therapy talking with me about different legendary skins and how they desperately want them because they’re worth so much money. I’ve had a lot of teens talk about Counter Strike: Global Offensive (CS:GO). According to this article, the most valuable skin is currently valued at 4,500…..for a virtual gun…that does nothing….but looks different than other peoples’ guns. Again, I’m going to make the slot machine reference here. People spend maybe….$3 to open a “crate”, but have a .0001% chance of getting anything good. There are thousands of videos on youtube of people desperately sinking 100’s of dollars into these virtual crates only to be disappointed by low quality skins they will never use. There’s much, much more to be said about all of this, but I want to cover it in a more extensive blog post later.
What Does Video Game Addiction Look Like?
You will know it when you see it. Teenagers are one of my specialties. I have worked with a lot of teenagers who play video games all the time, who are able to moderate their use and take time off from them with relative ease. When someone is addicted to video games you will see their mood change markedly when video games are taken away from them or they are unable to play. I have seen kids have their games grounded and they managed it well. On the other hand, I have seen kids have them grounded and they lost their minds and became destructive or collapsed into depression. This is where we have to get into the anatomy of addiction.
What is Addiction?
In psychology we try not to use the word addiction, and instead use dependence, because addiction is mostly about a person becoming dependent on something to function. We further break this down into physical dependence and psychological dependence. Physical is when your body gets used to a chemical being in the body, so it needs it to function normally. Psychological is when something just makes you feel really good so you want it all the time.
Video Games Create Both Physical and Psychological Dependence.
Video games can be highly enjoyable….that’s why they’re called games. Because of this, they are able to cause psychological dependence in people, where they end up wanting to play a lot and thinking about them a lot. Video games can also create physiological dependence too. When someone is playing a video game, the excitement, risk, fun, and even anger and frustration release chemicals in the brain. This is ok and normal. The problem is, any time you do something like this a lot, your brain gets used to it and attempts to maintain homeostasis by counteracting whatever chemicals are being released in the brain. To put it simply, if you’re playing really exciting video games all the time, excitement chemicals are being released in your brain. The brain eventually tries to counteract this by releasing chemicals that will sedate you. This is all fine and dandy until you remove the video games. After this it takes the brain a while to catch on, but until it does, it continues to release sedating chemicals and the person experiences an actual withdrawal. This typically takes the form of anhedonia, where the person has difficulty experiencing pleasure for a while. This is why you can spot video game addiction pretty easily. You will see it if the games go away and the person crumbles.
I should note here that I am not necessarily advocating for parents to take their kids’ video games away. A lot of people who are heavily involved in video games develop very real and important social relationships over their video games. We don’t yet fully understand the role these relationships can have in people’s lives. However, taking video games away from a person whose social life primarily revolves around them can be very difficult and detrimental to that person. Imagine if someone took your phone away and you couldn’t contact anyone you care about. Consider this when making decisions about your child’s gaming.
How Can We Help People Who are Addicted to Video Games
Because video game addiction is just now being recognized, there actually aren’t a lot of resources out there for help at this point. More and more treatment options are becoming available though, and now there are actually inpatient rehab facilities that treat video game addiction. If someone you love struggles with video game addiction, talk with them about it. If you are a parent, be careful how you approach your child and how you word things. They will likely suspect and fear that you will take their games away.
When I work with people who have clear video game addiction problems I frame it just like any other addiction for them. We talk about triggers, recognizing them, planning ahead for them, and building coping skills to deal with them when they come up. Video game addiction can be complicated, and just like any other addiction, it is important to know your triggers. I for example, have come to the realization that I cannot play any games with microtransactions. The last time I did I spent $400 on virtual cards, I chased a big win, like a gambler, and then crashed and felt empty….again. Talk with your loved one, and offer to connect them with support if you can. SacWellness is going to be home to many therapists who specialize in working with video game addiction. Try contacting one of them and see if they can help you.
About the Author
Joe Borders is a marriage and family therapist located in Roseville and Sacramento. He is primarily a sex positive gender therapist, but also specializes in working with couples, teens, addiction, and the LGBTQ community. Joe is also the owner and founder of SacWellness. You can find out more about him by visiting his sacwellness listing or by visiting his website: therapy and counseling in Roseville and Sacramento